Acceso a medicamentos para enfermedades agudas en países de renta media de América Central

Emmerick, Isabel Cristina Martins; Luiza, Vera Lucia; Camacho, Luiz Antonio Bastos; Ross-Degnan, Dennis

doi:10.1590/S0034-8910.2013047004307

OBJETIVO

: Analizar los principales predictores de acceso a medicamentos en condiciones agudas de salud.

MÉTODOS

: Estudio transversal analítico, basado en pesquisa domiciliar realizada en Nicaragua, Honduras y Guatemala. Se identificaron los predictores de: buscar cuidados para la condición aguda en el sistema formal de salud y obtener todos los medicamentos buscados para la condición aguda. Los datos fueron analizados con SPSS ^® v.17 usando estadísticas descriptivas y regresión logística multivariada.

RESULTADOS

: Hubo auto relato de enfermedad aguda en 48,3% de los 2.761 domicilios investigados, siendo 59,0% en Nicaragua, 56,2% en Honduras y 30,9% en Guatemala. Individuos con enfermedad aguda y peor percepción de la gravedad de la enfermedad o menores de 15 años con seguro salud tuvieron mayor chance de buscar cuidado. El acceso a medicamentos está fuertemente correlacionado con la búsqueda de cuidado, y la obtención de todos los medicamentos necesarios fue tres veces mayor en aquellos que buscaron el sistema formal de salud (OR 3,0; IC95% 2,3;4,0). Procurar el sector privado, tener alto nivel educativo y percepción positiva sobre la cualidad de cuidado y de los medicamentos aumentan el chance de acceso pleno a medicamentos dentro del sistema de salud. Para los pacientes que no buscaron el sector formal, el acceso pleno a los medicamentos fue más probable en Honduras o Nicaragua. Otros importantes predictores incluyen localización urbana, mayor estatus económico, y ser del sexo masculino.

CONCLUSIONES

: parte de la población en los tres países obtuvo medicamentos fuera del sistema formal de salud, lo que puede representar riesgo para los pacientes. Determinantes del acceso pleno a los medicamentos, dentro y fuera del sistema formal de salud, fueron distintos y así podrán exigir diferentes estrategias para mejorar el acceso a medicamentos.

Preparaciones Farmacéuticas; Accesibilidad a los Servicios de Salud; Control de Enfermedades Transmisibles; Encuestas Epidemiológicas, utilización; Estudios Transversales

[1] Correspondence
: Isabel Cristina Martins Emmerick. Pharmaceutical Policy Research Fellowship. Department of Population Medicine. Harvard Medical School & Harvard Pilgrim Health Care Institute. 133 Brookline Ave, 6 ^th Floor, Boston, MA 02215, USA. E-mail: emmerick.isabel@gmail.com

Variable	NIC	HON	GUT	Total

Total number of households	957	869	935	2,761
Number (percentage) of households that have an acute condition	565 (59.0)	488 (56.2)	289 (30.9)	1,342 (48.6)
Number of persons that have an acute condition per household [mean(SE)]	1.7 (0.06)	1.9 (0.06)	1.4 (0.09)	1.7 (0.04)
Households located less than 30 min from any health facility (%)	62.4	68.8	68.4	66.0 ^b
Households located in urban region (%)	47.5	52.2	48.4	50.6 ^h
Households with less than 3 persons per room (%) or (Households without overcrowding)	81.8	85.5	94.1	85.8 ^b,e,i
Economic level
A	21.4	22.7	19.1	21.4
B	42.8	43.0	46.0	43.6
C	35.8	34.4	34.9	35.1
Female head of household (%)	68.4	30.6	31.7	46.8
Head of household that read and write in Spanish (%)	80.2	79.3	85.2	80.9
Age of the head of household [mean (SE)]	45.5 (0.7)	46.6 (0.9)	43.4 (1.2)	45.4 (0.5)
Households not declaring that the mother has ethnic minority (%)	87.6	84.5	76.3	83.0 ^c,f
Personal educational level of head of household
None or less than primary school (%)	52.1	53.8	59.6	48.2
Primary school (%)	30.2	29.2	13.4	29.6
Secondary school and more (%)	17.7	17.1	27.1	22.2
Head of the household is employed (%)	27.4	35.9	27.6	30.5 ^b,i
Head of the household is retired (%)	4.7	7.0	6.1	5.9 ^g
Household Health insurance (%)	18.7	14.8	18.8	17.3 ^a,e,h
Household Health insurance that covers all medicines (%)	9.0	8.3	8.7	8.6 ^a,f,i
Perceptions (% households)
The geographic location of public health facility is good (%)	53.2	65.3	50.3	59.5
The opening times of public health facility are good (%)	50.9	64.3	48.3	61.1 ^h
The opening times of the pharmacy at public health facility are good (%)	45.0	63.8	41.7	60.1 ^g
The quality of the health care at public health facility is good (%)	45.8	62.6	37.3	53.2 ^g
The medicine quality at public health facility is good (%)	55.7	67.2	45.4	62.9 ^e,g

Variable	NIC	HON	GUT	Total

Number of households that have an acute condition	565	488	289	1,342
Person that had an acute condition
Female (%)	44.2	50.8	60.4	49.3 ^g
Age [mean(SE)]	20.4 (1.0)	22.2 (1.1)	19.4 (1.6)	20.8 (0.6)
Age under 15 (%)	52.9	52.1	52.6	52.6 ^a
Not an ethnic minority (%)	87.5	82.8	83.5	84.9
Read and write in Spanish (%)	84.1	78.6	79.6	81.2 ^f
Relationship with the head of household
Head of the household or spouse (%)	28.7	31.9	47.7	33.1
Son/ daughter/ grandchild/ stepchild (%)	66.9	63.6	47.0	62.8
Other relative (%)	3.8	3.7	5.2	4.0
Not related (%)	0.5	0.9	-	0.1
Sought Care in the formal health system	47.1	41.3	44.8	44.5
Obtained health care in the Health System	96.6	98.1	92.7	96.3
Sought Care in the Public Sector	33.7	26.8	26.5	29.7 ^d
Sought medicines	87.8	91.3	78.5	87.1
Full access to medicines	75.8	86.5	60.3	76.4
Perceived the acute condition as severe (%)	44.5	39.5	29.8	39.6 ^a
Health insurance (persons with acute condition) (%)	13.7	13.1	7.3	12.2 ^a,c,f
Health insurance covers medicines (persons with acute condition) (%)	5.5	8.7	3.3	6.1 ^a,d,g
Obtained medicines for free (%)	34.2	29.1	26.1	30.8

Variable	OR	CI

Seek care in the formal health care system
Country
Honduras	2.7	1.1;6.5
Nicaragua	1.9	1.0;4.2
Guatemala	1.0	–
Household Level
Economic Level
A	1.0	0.3;3.2
B	0.9	0.5;1.7
C	1.0	–
Household head education level
Secondary school	3.0	1.0;9.1
Primary school	1.0	0.6;1.8
None or < primary school	1.0	–
Individual Level
Sought health care in the private sector	3.2	1.5;7.0
Perceptions
Medicines quality at public health facility is good	2.0	1.1;3.5
Does not seek care in the formal health care system	OR	CI
Country
Honduras	9.5	5.3;16.8
Nicaragua	3.6	2.0;6.8
Guatemala	1.0	–
Household Level
Household in the urban area	1.3	0.8;2.0
Economic Level
A	1.9	0.9;3.9
B	1.5	0.9;2.4
C	1.0	–
Household head education level
Secondary school	1.4	0.7;2.8
Primary school	1.5	0.9;2.4
None or < Primary school	1.0	–
Individual Level
Male (%)	1.5	1.1;2.1

Variable	Nicaragua			Honduras			Guatemala

	Total	Seek care	Did not seek	Total	Seek care	Did not seek	Total	Seek care	Did not seek

Reasons for not having full access to medicines (n)	136	37	99	62	17	45	100	24	76
Do not have money (%)	62.7	61.8	63.0	62.0	57.7	63.7	24.4	37.6	20.1
Medicines were not available at the pharmacy or health care facility (%)	29.0	59.5	17.5	11.0	32.9	2.4	5.5	16.8	1.9
Place where medicines can be obtained was too far away (%)	26.7	7.8	33.8	10.7	0.0	15.0	1.9	4.0	1.3
Medicines do not have good quality (%)	1.5	2.9	1.0	1.7	0.0	2.4	2.0	0.0	2.6
Medicines were not needed (%)	18.1	0.0	24.9	35.2	19.8	40.9	44.1	9.6	55.2
Prices of medicines are high (%)	13.0	13.4	12.9	6.6	–	9.1	2.1	0.0	2.8
Doctor did not prescribe medicines (%)	–	5.4	–	–	6.3	–	–	14.6	–