Use of health services and medicines by hypertensive and diabetic patients in the municipality of Rio de Janeiro, Brazil

Freitas, Paula da Silva; Matta, Samara Ramalho; Mendes, Luiz Villarinho Pereira; Luiza, Vera Lucia; Campos, Monica Rodrigues

doi:10.1590/1413-81232018237.21602016

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FREE THEMES • Ciênc. saúde colet. 23 (7) • July 2018 • https://doi.org/10.1590/1413-81232018237.21602016 copy

Use of health services and medicines by hypertensive and diabetic patients in the municipality of Rio de Janeiro, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to describe and analyze factors associated with emergency care and hospitalization of hypertensive and diabetic patients in the municipality of Rio de Janeiro, especially those related to the use of medicines. This is across-sectional study using secondary database from a household survey that approached hypertensive and diabetic patients. The outcome variables were: 1) seek for emergency careasa resultof complications related to hypertension and diabetes in the 12months preceding the interviews; 2) hospitalizationin the same period andfor the same reasons. Uni and bivariate analysis between exposure variables and each of the outcomes were performed using chi-square test at a significance level of 10%, which originated multivariate logistic regression analysis. Negative self-evaluation of health status was associated with both outcomes in the multivariate analysis. Having stopped taking the medications was associated with hospitalization and having missed a medical appointment in the last six months was associated with search for emergency care.

Primary Health Care; Use of medicines; Hypertension; Diabetes; Emergency medical services

Indicator/variable	N	Result
Sociodemographic profile
Age (mean)	547	62.7 years
Female sex	372	68.0%
Ethnicity
White	190	35.1%
Brown	224	41.3%
Blacks	96	17.7%
Others	32	5.9%
Marital status
Married	287	52.5%
Single	89	16.3%
Widowed	126	23.0%
Others	45	8.2%
Living alone	55	10.1%
Occupation
Working (formal or informal market)	164	30.0%
Retired	235	43.0%
Taking care of the house or family	134	24.5%
Others	14	2.5%
Economic class
A	1	0.2%
B	55	10.0%
C	362	66.2%
D/E	119	21.8%
Health conditions
Hypertension	526	96.2%
Diabetes	114	20.8%
Knowledge of the diagnosis for more than 5 years	477	87.4%
Self-assessment of health status
Very good or good	179	33.0%
Fair	329	60.6%
Poor or very poor	35	6.4%
Self-assessment of health status in relation to other people at your age
Very good or good	219	41.9%
Fair	267	51.1%
Poor or very poor	37	7.1%
Degree of difficulty in performing work/household tasks
None, mild or fair	471	86.3%
High/extreme	75	13.7%
Aspects related to the use of health services
You have missed a scheduled consultation at the BHU in the last 6 months	105	19.2%
You have scheduled the date of the next consultation at the BHU	324	61.8%
Satisfied or very satisfied with the pharmacy service	429	78.6%
Indication of exercises by the physician	353	64.5%
Indication of diet by the physician	305	55.8%
Aspects related to the use of medicines
You usually stop taking your medicines	123	22.5%
DM and AA drugs are usually left over	127	23.2%
Expired drugs/damaged packaging at home	263	48.1%
All medications used for AH/DM were prescribed by prescribers	527	96.3%
You usually ask for information about medicines only for health professionals	339	62.0%
More than 1 year without change in the prescription of medicines for hypertension and/or diabetes	362	73.4%
Having used medications for hypertension or diabetes for more than 5 years	471	86.4%

Indicator/variable	Category	Total	Have you sought for emergency care?		Have you been hospitalized?

			%	P value ^(#)	%	P value^(#)
Sociodemographic data
Sex	Male **	175	19.4%	0.626	2.9%	0.032*
Sex	Female	372	21.2%	0.626	7.5%	0.032*
Ethnicity	Non-whites**	352	21.9%	0.343	8.0%	0.013*
Ethnicity	Whites	190	18.4%	0.343	2.6%	0.013*
Health conditions
Diabetes	No **	433	20.1%	0.524	4.8%	0.024*
Diabetes	Yes	114	22.8%	0.524	10.5%	0.024*
Self-assessment of health status	Good/very good **	179	11.7%	< 0.001*	2.8%	0.025*
Self-assessment of health status	Fair, poor and very poor	364	25.3%	< 0.001*	7.7%	0.025*
Self-assessment of health status in relation to other persons of the same age	Good/very good **	219	16.0%	0.013*	2.7%	0.004*
	Fair, poor and very poor	304	25.0%	0.013*	8.9%	0.004*
Degree of difficulty in performing work/household tasks	None, mild or fair **	471	18.0%	< 0.001*	5.3%	0.070*
Degree of difficulty in performing work/household tasks	High and extreme	75	37.3%	< 0.001*	10.7%	0.070*
Time during which the medical prescription for AH/DM is unchanged	> 1 year **	362	18.8%	0.037*	5.8%	0.899
	£1 year	131	27.5%	0.037*	6.1%	0.899
Aspects related to the use of health services
Have you missed a consultation scheduled at the BHU in the last 6 months?	No **	442	18.3%	0.006*	5.0%	0.033*
	Yes	105	30.5%	0.006*	10.5%	0.033*
Have you scheduled the date of the next consultation at the BHU?	Yes**	324	21.6%	0.474	7.4%	0.066*
	No	200	19.0%	0.474	3.5%	0.066*
Aspects related to the use of medicines
Do you usually fail in taking your medicines?	No **	424	19.3%	0.157	4.7%	0.016*
Do you usually fail in taking your medicines?	Yes	123	25.2%	0.157	10.6%	0.016*
Are the DM and HA drugs usually left over?	No**	419	20.5%	0.858	4.5%	0.007*
Are the DM and HA drugs usually left over?	Yes	127	21.3%	0.858	11.0%	0.007*
Do you usually ask for information about medicines only for health professionals?	Yes **	339	21.8%	0.388	4.7%	0.100*
	No	208	18.8%	0.388	8.2%	0.100*

Indicator/variable	Adjusted OR (95% CI)	P_value
Search for emergency care due to AH/DM-related complications in the 12 months prior to the interview (PTC**:73.7 %)
Self-assessment of health status as fair, poor or very poor	2.27 (1.28-4.00)	0.005*
High/extreme degree of difficulty in carrying out work/household tasks	2.41 (1.37-4.26)	0.002*
Medical prescription for AH/DM unchanged for less than 1 year	1.52 (0.93-2.98)	0.092
Having missed a scheduled consultation at the BHU in the last 6 months	1.80(1.05-3.09)	0.033*
Hospitalization due to AH/DM-related complications in the 12 months prior to the interview (PTC**: 94.5%)
Female sex	2.82 (1.01-7.88)	0.048*
Non-white ethnicity	4.35 (1.39-14.9)	0.012*
Having diabetes	2.25 (0.96-5.28)	0.061
Self-assessed health status compared to other people at the same age as fair, poor or very poor	5.26 (1.79-14.29)	0.002*
Having missed a consultation scheduled at the BHU in the last 6 months	2.42 (0.99-5.95)	0.052
Having scheduled the date of the next consultation at the BHU	2.63 (1.02-6.67)	0.045*
Usually fails to take medicines	2.38 (1.01-5.56)	0.048*
DM and AH drugs are usually left over	2.27 (0.95-5.56)	0.067
Usually not asking for information about medicines only for health professionals	2.08 (0.94-4.76)	0.072

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[1] Collaborations

PS Freitas, LVP Mendes and MR Campos participated in the conception and design, writing, analysis of data and revision of article. VL Luiza participated in the writing, analysis of data and revision of article. SR Matta participated in the writing and revision of article. LVP Mendes and SR Matta participated in the orientation of academic work.