Access to prescribed medicine in the Brazilian adult population

Drummond, Elislene Dias; Simões, Taynãna César; Andrade, Fabíola Bof de

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Brasil

Revista Brasileira de Epidemiologia

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Brasil

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Sumário

ORIGINAL ARTICLE • Rev. bras. epidemiol. 21 • 2018 • https://doi.org/10.1590/1980-549720180007 copy

Access to prescribed medicine in the Brazilian adult population

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

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.

Keywords:
Pharmaceutical services; Epidemiology; Access to essential medicines and health technologies

	(%)	Total	Partial	Null	p-value
Sex
Male	36.5	85.3	7.7	7.0	0.03
Female	63.5	81.7	11.0	7.3	0.03
Age (years)
18 to 39	33.8	83.5	8.2	8.3	0.29
40 to 59	37.4	82.7	10.5	6.9
60 or older	28.8	82.9	10.8	6.4
Skin color
White	51.5	84.4	10.0	5.6	< 0.01
Non-white	48.5	81.4	9.6	8.9	< 0.01
Schooling (years)
0 to 3	25.1	79.0	13.7	7.3	< 0.01
4 to 7	19.6	82.1	10.8	7.1
8 to 11	37.5	83.5	8.6	7.9
12 or more	17.8	88.5	5.7	5.8
Physical activity
No	80.6	81.7	10.7	7.6	< 0.01
Yes	19.4	88.3	6.1	5.6	< 0.01
Number of chronic diseases
0	45.3	83.4	8.5	8.1	0.06
1 or more	54.7	82.6	10.9	6.5	0.06
Household enrolled in ESF
No	32.7	85.3	8.0	6.6	< 0.01
Yes	57.6	80.7	11.4	7.8
Does not know	9.6	88.5	6.0	5.4
Filliation to a health plan insurance
No	64.7	80.0	12.5	7.6	< 0.01
Yes	35.3	88.5	4.9	6.5	< 0.01
Place of service
Public	62.5	79.6	13.2	7.2	< 0.01
Private	37.5	88.6	4.2	7.2	< 0.01

Reason for not accessing the medication	Brazil (%)	North* (%)	Northeast (%)	Southeast (%)	South (%)	Center-West (%)
Did not obtain it in the public health service, because the drugstore was closed.	5.3	11.1	5.9	3.7	7.9	0.4
The medicines were not available in the health service.	57.6	61.8	54.4	58.8	58.6	53.7
Could not get the medicine(s) in the Popular Drugstore Program.	4.5	2.4	0.8	6.1	5.1	7.8
There was no drugstore close by or had difficulties with transportation.	1.7	1.9	2.0	1.5	2.4	0.0
Could not find all medicines in the drugstore.	4.7	2.4	6.4	4.7	3.6	4.4
had no Money to buy them.	11.9	13.9	17.3	8.9	9.5	17.2
Did not think they were necessary.	7.3	3.0	6.0	9.4	5.3	6.9
Gave up looking, because felt like got better..	0.6	0.0	0.2	0.4	0.0	5.0
Another reason	6.4	3.4	6.9	6.6	7.6	4.7

	Brazil OR (95%CI)**
Partial access
Sex (male)^†
Female	1.45 (1.06 - 1.99)*
Age (18 to 39 years)^†
40 to 59	1.10 (0.74 - 1.63)
60 or more	1.09 (0.70 - 1.70)
Color (white) ^†
Non-white	0.77 (0.57 - 1.03)
Macro-region (North)^†
Northeast	0.44 (0.28 - 0.70)*
Southeast	0.50 (0.32 - 0.79)*
South	0.45 (0.28 - 0.74)*
Center-West	0.51 (0.32 - 0.81)*
Place of last appointment (private)^†
Public	2.51 (1.58 - 3.97)*
Null access
Sex (male) ^†
Female	1.05 (0.76 - 1.45)
Age (18 to 39 years)^†
40 to 59	0.87 (0.62 - 1.22)
60 or more	0.84 (0.49 - 1.45)
Color (white) ^†
Non-white	1.43 (1.03 - 1.99)*
Place of last appointment (private)^†
Public	0.82 (0.57 - 1.19)

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[1] Corresponding author: Elislene Dias Drummond. Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz. Avenida Augusto de Lima, 1.715, Barro Preto, CEP: 30190-002, Belo Horizonte, MG, Brasil. E-mail: elislene.drummond@minas.fiocruz.br