Prevalência e fatores associados ao acesso a medicamentos pela população idosa em uma capital do sul do Brasil: um estudo de base populacional

[Prevalence rates and inequalities in access to medicines by users of the Brazilian Unified National Health System in 2013 and 2019]

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.

Medication use among quilombola and non-quilombola rural adolescents in the countryside of Bahia, Brazil

This study aims to describe the use of prescribed and non-prescribed medications and associated factors among adolescents living in rural, quilombolas and non-quilombolas communities in the interior of Bahia, Brazil. This is a population-based survey with 390 adolescents between 10 and 19 years old in 2015. Prevalence and odds ratio for use of prescribed and non-prescribed medication, and multiple analysis was conducted by Multinomial Logistic Regression. Among the interviewees, 13.6% used only prescribed medications and 14.4% only used non-prescribed medications. Quilombolas demonstrated a greater diversity of pharmaceutical specialties used. The low prevalence of medication use in both groups of adolescents suggests less access to these products. Despite this, it was observed the irrational use of medication, mainly as self-medication. Quilombola adolescents, although they belong to the same area of coverage of other communities, presented different associated factors when compared to the non-quilombola group: the presence of toothache in the last 6 months and have had a regular source of care increased the use of prescribed medications.

Free access to medicines among older adults in primary care: a cross-sectional study

BACKGROUND

Access to medicines is an important indicator of healthcare system quality and capacity to resolve problems. The healthcare system needs to ensure free access to medicines for elderly people, in order to provide greater effectiveness of disease control, thus reducing morbidity and mortality, and improving health and quality of life.

OBJECTIVES

To analyze the frequency of free access to medication among older adults within primary care and determine the factors associated with free access.

DESIGN AND SETTING

Cross-sectional study at two primary care units.

METHODS

Free access was defined as provision of all medicines through pharmacies within the Brazilian National Health System and through the Brazilian program for free medicines in private pharmacies. We investigated the sociodemographic, clinical, functional and pharmacotherapeutic characteristics of older adults. Multivariate logistic regression was performed to identify factors associated with free access to medicines.

RESULTS

This study included 227 older adults, among whom 91 (40.1%) had free full access to prescription drugs. A direct association with age ≤ 70 years and indirect associations with polypharmacy and multimorbidity (P < 0.05) were found.

CONCLUSIONS

Age ≤ 70 years increases the likelihood of having free full access to medicines, and older adults with multimorbidity and polypharmacy use have a lower likelihood of access. Identification of factors associated with free access to medicines among elderly people provides elements to guide the Brazilian National Health System in implementing access improvement actions.

Access to prescribed medicine in the Brazilian adult population

OBJECTIVE

To estimate the prevalence and check the factors associated with access to prescribed medicine by the Brazilian adult population; and to describe the distribution of the presence of monetary expenditure for the purchase, source of medicines, and the reasons for non-access.

METHODS

Based on a cross-sectional design, from the 2013 National Health Research data, we analyzed a representative sample of the population that comprised adults with prescriptions written by a health professional, in the two weeks prior to the survey. The dependent variable was the access to prescribed medicines (full access, partial access, no access). Data were analyzed using the multinomial logistic regression considering total access as the reference category.

RESULTS

The results showed high prevalence of full access to prescribed medicine in Brazil (83.0%; 95%CI 81.3 - 84.6). Most of the individuals had monetary expenditure on the purchase of medicines (63.9%), and the main reasons for no access were the lack of medicine in the public health service (57.6%) and having no money (11.9%). We found higher chances of partial access among individuals attending the public service (OR = 2.5; 95%CI 1.58 - 3.97). Greater chance of no access was associated with non-white skin color (OR = 1.43; 95%CI 1.03 - 1.99).

CONCLUSION

The results revealed significant inequity in access to medicine, emphasizing the need to strengthen the Unified Health System for the free supply of medicines in order to reduce inequalities.

Adesão ao tratamento farmacológico da hipertensão arterial na Atenção Primária à Saúde

RESUMO Objetivou-se verificar a adesão ao tratamento farmacológico da hipertensão arterial e fatores associados à baixa adesão em hipertensos adstritos à Atenção Primária à Saúde. Estudo transversal, realizado em duas Estratégias Saúde da Família em um município da região Noroeste do estado do Rio Grande do Sul. A coleta de dados foi realizada em domicílio no período de janeiro a maio de 2016. Para verificar a adesão ao tratamento, utilizou-se o Brief Medication Questionnaire. Participaram do estudo 145 hipertensos de ambos os sexos. Identificaram-se valores pressóricos mais elevados entre os hipertensos com baixa adesão do que entre os aderentes. Em relação à associação de medicamentos anti-hipertensivos, verificou-se que quanto maior o número de medicamentos utilizados, menor a adesão. Os fatores relacionados com a diminuição da adesão foram: baixa renda, uso de dois ou mais anti-hipertensivos e dificuldades para ler a embalagem dos medicamentos.

Sources for obtaining drugs for hypertension in Brazil: results from the National Health Survey, 2013

OBJECTIVE

To analyze the sociodemographic differences among adults with hypertension regarding the sources for obtaining drugs for hypertension treatment in Brazil.

METHODS

This is a secondary analysis of data from the National Health Survey 2013; the outcomes considered for the analysis were the sources for obtaining drugs for treating high blood pressure.

RESULTS

The great majority (74%) of patients with hypertension taking drugs use a single source for obtaining them, 7.3% (95%CI 6.4 - 8.4) reported getting all the drugs through private health plans, 22.7% (95%CI 21.0 - 24.4) by pharmacies of the public health system, 21.8% (95%CI 20.2 - 23.4) by the Popular Pharmacy Program, and about one-third (29.5%; 95%CI 27.7 - 31.4) exclusively by commercial pharmacies. Having the public health system as the single source for obtaining the drugs was found to decrease with age, was lower in white people, decreased strongly with increase in education, and was lower for residents in the North region. Exclusive obtainment through the Popular Pharmacy Program was lower for people with higher education. Obtainment in commercial pharmacies was positively associated with being male, with higher education level, being older, and having white skin color. Obtainment using more than one source was positively associated with increasing age and inversely associated with higher education levels.

CONCLUSIONS

The results allowed the identification of a trajectory of patients in obtaining drugs for the treatment of hypertension, aiming at explaining how the drugs are obtained and the impact of public policies in this sector in the country.

Use of and access to health services in Brazil, 2013 National Health Survey

OBJECTIVE

To analyze the use of health services in the Brazilian population by sociodemographic factors, according to data from the 2013 Brazilian National Health Survey.

METHODS

The study analyzed data from 205,000 Brazilian citizens in all age groups who participated in the Brazilian National Health Survey, a cross-sectional study carried out in 2013. Prevalence and confidence intervals were estimated for indicators related to access to and use of health services according to age group, level of education of head of household, and Brazilian macroregions.

RESULTS

Among individuals who sought health services in the two weeks prior to the survey, 95.3% (95%CI 94.9-95.8) received care in their first visit. Percentages were higher in the following groups: 60 years of age and over; head of household with complete tertiary education; living in the South and Southeast regions. In addition, 82.5% (95%CI 81.2-83.7) of individuals who received health care and prescriptions were able to obtain all the necessary medicines, 1/3 of them from SUS. Less than half the Brazilian population (44.4%; 95%CI 43.8-45.1) visited a dentist in the 12 months prior to the survey, with smaller percentages among the following groups: 60 years of age or older; head of household with no education or up to incomplete elementary; living in the North region of Brazil.

CONCLUSIONS

People living in the South and Southeast regions still have greater access to health services, as do those whose head of household has a higher level of education. The (re)formulation of health policies to reduce disparities should consider differences encountered between regions and social levels.

OBJETIVO

Descrever o uso de serviços de saúde na população brasileira segundo fatores sociodemográficos, de acordo com dados da Pesquisa Nacional de Saúde, 2013.

MÉTODOS

Foram analisados dados referentes a 205 mil brasileiros, de todas as faixas etárias, que participaram da Pesquisa Nacional de Saúde, estudo transversal conduzido em 2013. Calcularam-se as prevalências e seus intervalos de confiança para indicadores referentes ao acesso e a utilização dos serviços de saúde, segundo grupos de idade, nível de instrução do chefe da família e macrorregiões do país.

RESULTADOS

Dentre os indivíduos que procuraram o serviço de saúde nas duas semanas prévias à pesquisa, 95,3% (IC95% 94,9-95,8) conseguiu usá-lo na primeira vez que procurou. As proporções foram maiores: no grupo de 60 anos ou mais; cujo chefe da família tinha nível superior completo; e nas regiões Sul e Sudeste. Ainda, dos indivíduos atendidos e que tiveram medicamentos receitados, 82,5% (IC95% 81,2-83,7) conseguiram obter todos os medicamentos, sendo 1/3 pelo SUS. Menos da metade da população brasileira (44,4%; IC95% 43,8-45,1) consultou um dentista nos 12 meses anteriores à pesquisa, com proporções menores entre: indivíduos com 60 anos ou mais; cujo chefe da família não possuía nível de instrução ou tinha até o fundamental incompleto; e indivíduos que residiam na região Norte do país.

CONCLUSÕES

Pessoas que residem nas regiões Sul e Sudeste ainda possuem maior acesso aos serviços de saúde, bem como aquelas cujo chefe da família tem maior nível de instrução. A (re)formulação de políticas de saúde no intuito de reduzir disparidades deve considerar as diferenças regionais e entre níveis sociais encontradas.

Access to and use of high blood pressure medications in Brazil

OBJECTIVE

To analyze the access to and use of medicines for high blood pressure among the Brazilian population according to social and demographic conditions.

METHODS

Analysis of data from 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 nationwide cross-sectional, population-based study, with probability sampling, carried out between September 2013 and February 2014 in urban households in the five Brazilian regions. The study evaluated the access and use of medicines to treat people with high blood pressure. The independent variables were gender, age, socioeconomic status and Brazilian region. The study also described the most commonly used drugs and the percentage of people treated with one, two, three or more drugs. Point estimations and confidence intervals were calculated considering the sample weights and sample complex plan.

RESULTS

Prevalence of high blood pressure was 23.7% (95%CI 22.8-24.6). Regarding people with this condition, 93.8% (95%CI 92.8-94.8) had indication for drug therapy and, of those, 94.6% (95%CI 93.5-95.5) were using the medication at the time of interview. Full access to medicines was 97.9% (95%CI 97.3-98.4); partial access, 1.9% (95%CI 1.4-2.4); and no access, 0.2% (95%CI 0.1-0.4). The medication used to treat high blood pressure, 56.0% (95%CI 52.6-59.2) were obtained from SUS (Brazilian Unified Health System), 16.0% (95%CI 14.3-17.9) from Popular Pharmacy Program, 25.7% (95%CI 23.4-28.2) were paid for by the patients themselves and 2.3% (95%CI 1.8-2.9) were obtained from other locations. The five most commonly used drugs were, in descending order, hydrochlorothiazide, losartan, captopril, enalapril and atenolol. Of the total number of patients on treatment, 36.1% (95%CI 34.1-37.1) were using two medicines and 13.5% (95%CI 12.3-14.9) used three or more.

CONCLUSIONS

Access to medicines for the treatment of high blood pressure may be considered high and many of them are available free of charge. The most commonly used drugs are among those recommended as first-line treatment for high blood pressure control. The percentage of people using more than one drug seems to follow the behavior observed in other countries.

OBJETIVO

Analisar o acesso e a utilização de medicamentos para a hipertensão na população brasileira segundo condições sociais e demográficas. Análise dos dados da Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, estudo nacional de delineamento transversal de base populacional, com amostra probabilística, realizado entre setembro de 2013 e fevereiro de 2014 em domicílios urbanos nas cinco regiões do Brasil. Avaliou-se o uso e acesso aos medicamentos para os cuidados com pessoas que apresentam hipertensão arterial. As variáveis independentes utilizadas foram sexo, idade, nível socioeconômico e região do País. Também foram descritos os fármacos mais utilizados e a proporção de pessoas tratadas com um, dois, três ou mais fármacos. As estimativas de ponto e os intervalos de confiança foram calculados considerando os pesos amostrais e o plano complexo da amostra. A prevalência de hipertensão arterial foi de 23,7% (IC95% 22,8-24,6). Das pessoas com a condição, 93,8% (IC95% 92,8-94,8) tinham indicação de tratamento com medicamentos e, destes, 94,6% (IC95% 93,5-95,5) estavam usando os medicamentos no momento da entrevista. O acesso total aos medicamentos foi de 97,9% (IC95% 97,3-98,4); o acesso parcial, de 1,9% (IC95% 1,4-2,4); e o acesso nulo, de 0,2% (IC95% 0,1-0,4). Dos medicamentos utilizados para tratar a hipertensão, 56,0% (IC95% 52,6-59,2) foram obtidos no SUS, 16,0% (IC95% 14,3-17,9), no Programa Farmácia Popular, 25,7% (IC95% 23,4-28,2) pago do próprio bolso e 2,3% (IC95% 1,8-2,9) em outros locais. Os cinco fármacos mais utilizados foram, em ordem descrente, hidroclorotiazida, losartana, captopril, enalapril e atenolol. Do total de tratados, 36,1% (IC95% 34,1-37,1) estavam usando dois fármacos e 13,5% (IC95% 12,3-14,9) utilizavam três ou mais fármacos.

CONCLUSÕES

: O acesso aos medicamentos para tratamento da hipertensão pode ser considerado elevado e grande parte desses medicamentos é obtida gratuitamente. Os fármacos mais utilizados estão entre os preconizados como de primeira linha para o controle de hipertensão arterial. A proporção de pessoas utilizando mais de um fármaco parece seguir o comportamento observado em outros países.

Access to medicines for chronic diseases in Brazil: a multidimensional approach

OBJECTIVE

To analyze the access to medicines to treat non-communicable diseases in Brazil according to socioeconomic, demographic, and health-related factors, from a multidimensional perspective.

METHODS

Analysis of data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), household survey, sampling plan by conglomerates with representativeness of the Brazilian population and large areas of the country, according to sex and age domains. Data collected in 2013-2014 with sample of adults (≥ 20 years) who reported having non-communicable diseases and medical indication for use of medicines (n = 12,725). We assessed the prevalence of access to medicines for self-reported non-communicable diseases, considering four dimensions: availability, geographic accessibility, acceptability, and affordability. We applied Pearson's Chi-square test to assess the statistical significance of the differences between strata, considering the level of significance of 5%. We found prevalence of 94.3%, 5.2%, and 0.5% for full, partial, and null access, respectively. Higher prevalence was observed among seniors in the South compared to the Northeast; for those who reported having one non-communicable disease compared to those who reported having two or more; for those who needed one medicine compared to those who needed three or more; and for those who self-assessed their health as good or very good. Geographic accessibility was similar in the Unified Health System and in the private pharmacies (72.0%). Total availability of medicines was 45.2% in the Unified Health System, 67.4% in the Popular Pharmacy Program, and 88.5% in private pharmacies. Acceptability was 92.5% in the Unified Health System, 97.8% in the Popular Pharmacy Program, and 98.7% in private pharmacies. As to affordability, 2.6% of the individuals failed to take the medicines they should in the 30-day period prior to the interview due to financial difficulty. Prevalence of full access to medicines for non-communicable diseases in Brazil is high and presents significant differences for age group, region of the country, number of non-communicable diseases, and for medicines prescribed and self-assessment of health. The major barriers to access to medicines were identified in the dimensions analyzed.

OBJETIVO

Analisar o acesso a medicamentos para tratar doenças crônicas não transmissíveis no Brasil segundo fatores socioeconômicos, demográficos e de saúde, sob perspectiva multidimensional.

MÉTODOS

Análise de dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar, plano amostral por conglomerados com representatividade da população brasileira e grandes regiões do País, segundo domínios de sexo e idade. Dados coletados em 2013-2014 com amostra constituída por adultos (≥ 20 anos) que referiram ter doenças crônicas não transmissíveis e indicação médica para usar medicamentos (n = 12.725). Avaliou-se a prevalência de acesso aos medicamentos para doenças crônicas não transmissíveis autorreferidas, considerando quatro dimensões: disponibilidade, acessibilidade geográfica, aceitabilidade e capacidade aquisitiva. Aplicou-se teste Qui-quadrado de Pearson para avaliar a significância estatística das diferenças entre os estratos, considerando o nível de significância de 5%.

RESULTADOS

Foram encontradas prevalências de 94,3%, 5,2% e 0,5% para acesso total, parcial e nulo, respectivamente. Maiores prevalências ocorreram entre os idosos, na região Sul comparada à região Nordeste; naqueles que referiram ter uma doença crônica não transmissível comparados aos que referiram ter duas ou mais; naqueles que precisavam de um medicamento comparados aos que precisavam de três ou mais; e naqueles que autoavaliaram sua saúde como boa ou muito boa. A acessibilidade geográfica foi semelhante no Sistema Único de Saúde e nas farmácias privadas (72,0%). A disponibilidade total de medicamentos foi de 45,2% no Sistema Único de Saúde, 67,4% no Programa Farmácia Popular e 88,5% nas farmácias privadas. A aceitabilidade foi de 92,5% no Sistema Único de Saúde, 97,8% no Programa Farmácia Popular e 98,7% nas farmácias privadas. Quanto à capacidade aquisitiva, 2,6% dos indivíduos não tomou os medicamentos que deveria nos 30 dias anteriores à entrevista devido à dificuldade financeira.

CONCLUSÕES

A prevalência do acesso total aos medicamentos para doenças crônicas não transmissíveis no Brasil é alta e apresenta diferenças significativas por faixa etária, região do País, número de doenças crônicas não transmissíveis e de medicamentos prescritos e autoavaliação da saúde. Foram identificadas as principais barreiras ao acesso a medicamentos nas dimensões analisadas.

Free access to medicines for the treatment of chronic diseases in Brazil

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.

[Access to medicines prescribed for acute health conditions in adults in South and Northeast Brazil]

This was a cross-sectional study within Brazil's Project for the Expansion and Consolidation of Family Health, 2005, with the objective of universal and free access to the medication prescribed in the last medical appointment for acute health problems and to estimate the degree to which access may have improved with inclusion of the medicines in prevailing policies and programs. The sample included 4,060 adults living in the area of primary health care units in 41 municipalities in South and Northeast Brazil. Access was greater in the South (83.2%) than in the Northeast (71%), and free access was similar (37%), with a greater share by the Family Health Program (FHP) when compared to the traditional model, especially in the Northeast. Some 60% of prescribed medicines and 50% of those on the National List of Essential Medicines (RENAME) were paid for. No variation was observed in the proportion of medicines present on the prevailing RENAME list and access. However, 40% of the medicines that were paid for can currently be obtained through the Popular Pharmacy Program. The latter program appears to emerge as a new way to guarantee access to medicines prescribed in the health system.

[Inequality in Brazilian women's access to medicines for chronic diseases]

This study aimed to assess the prevalence of access to continuous prescription drugs for a group of chronic diseases and to investigate the existence of socioeconomic inequalities in access. The data are from the Brazilian National Demographic and Health Survey on Women and Children (2006), with a sample of 15,575 women 15 to 49 years of age. Among these women, 7,717 were diagnosed with a chronic disease that required acquiring medicine and were considered eligible for the study. The dependent variable was defined as the diagnosis of a chronic disease and the need to obtain medication for treatment. Multivariate analysis used Poisson regression. Higher access was associated with residence in a rural area, having one or two chronic diseases, and higher socioeconomic status. Prevalence of access to medication was high, but the analysis revealed socioeconomic inequality in access to medicines in favor of the wealthy, while identifying the most vulnerable groups as the poorest and those with more chronic diseases.

Conduta do tratamento medicamentoso por cuidadores de idosos

O envelhecimento populacional está ampliando o número de cuidadores de idosos no Brasil. A farmacoterapia compreende um sistema complexo de atividades e a sua condução está presente no rol de tarefas desempenhadas por esses atores. Além disso, a conduta do tratamento pode estar sujeita a diversos problemas na sua execução, com destaque para: dificuldades de administração dos medicamentos, falta de acesso aos medicamentos, obstáculos na realização de observação clínica, assim como os desafios presentes no estabelecimento de uma comunicação efetiva com os idosos e profissionais de saúde. O presente estudo trata de uma revisão cujo objetivo é ampliar as discussões sobre os aspectos supracitados, de modo que este debate dê subsídios teóricos aos programas e serviços na área de gerontologia.

Access to continued-use medication among older adults, Brazil

OBJECTIVE To determine the prevalence and associated access factors for all continued-use prescription drugs and the ways in which they can be obtained. METHODS Data was obtained from the 2008 Household National Survey. The sample comprised 27,333 individuals above 60 years who reported that they used continued-use prescription drugs. A descriptive analysis and binary and multiple multinomial logistic regressions were performed. RESULTS 86.0% of the older adults had access to all the medication they needed, and among them, 50.7% purchased said medication. Those who obtained medication from the public health system were younger (60-64 years), did not have health insurance plans, and belonged to the lower income groups. It is remarkable that 14.0% of the subjects still had no access to any continued-use medication, and for those with more than four chronic diseases, this amount reached 22.0%. Those with a greater number of chronic diseases ran a higher risk of not having access to all the medication they needed. CONCLUSIONS There are some groups of older adults with an increased risk of not obtaining all the medication they need and of purchasing it. The results of this study are expected to contribute to guide programs and plans for access to medication in Brazil.

[Non-adherence to continuous treatment and associated factors: prevalence and determinants in adults 40 years and older]

This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A population-based survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed socio-demographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society.

Consumo de medicamentos por idosos, Goiânia, Brasil

OBJETIVO: Analisar o padrão de consumo de medicamentos entre idosos e sua associação com aspectos socioeconômicos e autopercepção de saúde. MÉTODOS: Estudo de base populacional e delineamento transversal com 934 idosos de Goiânia, GO, Brasil, entre dezembro de 2009 e abril de 2010. Os dados foram coletados por meio de questionário. As variáveis estudadas foram: número de medicamentos consumidos, sexo, estado civil, escolaridade, tipo de moradia, idade, renda e autopercepção de saúde. Os medicamentos foram classificados segundo o Anatomical Therapeutic and Chemical Classification. Os medicamentos impróprios para idosos foram identificados segundo o Critério de Beers-Fick. Os testes utilizados foram Qui-quadrado (X²) e exato de Fisher e p foi considerado significativo quando < 0,05. RESULTADOS: Os idosos consumiam 2.846 medicamentos (3,63 medicamentos/idoso). Os mais usuais atuavam no aparelho cardiovascular (38,6%). A prevalência de polifarmácia foi de 26,4% e da automedicação de 35,7%. Os medicamentos mais ingeridos por automedicação foram os analgésicos (30,8%); 24,6% dos idosos consumia medicamento considerado impróprio. Mulheres, viúvos, idosos com 80 anos ou mais e com pior autopercepção de saúde praticavam mais a polifarmácia. A maior prática da automedicação esteve associada com menor escolaridade e pior autopercepção de saúde. CONCLUSÕES: O padrão do consumo de medicamentos por idosos foi semelhante ao encontrado em idosos de outras regiões do Brasil. O número de medicamentos usados, a prevalência das práticas da polifarmácia e automedicação e consumo de medicamentos impróprios estiveram dentro da média nacional.