Access to medicines by patients of the primary health care in the Brazilian Unified Health System

Álvares, Juliana; Guerra Junior, Augusto Afonso; Araújo, Vânia Eloisa de; Almeida, Alessandra Maciel; Dias, Carolina Zampirolli; Ascef, Bruna de Oliveira; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Acurcio, Francisco de Assis

doi:10.11606/S1518-8787.2017051007139

Acessibilidade / Reportar erro

Brasil

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Sumário

Original Articles • Rev. Saúde Pública 51 (suppl 2) • 2017 • https://doi.org/10.11606/S1518-8787.2017051007139 copy

Access to medicines by patients of the primary health care in the Brazilian Unified Health System

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective.

METHODS

This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators.

RESULTS

For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines.

CONCLUSIONS

Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.

Pharmaceutical Services; Health Services Accessibility; Primary Health Care; Health Services Research; Brazilian Unified Health System

Access Dimensions	Concept^*	Indicator	n	% (95%CI)
Availability	Relationship between the type of services and volume of existing resources according to the needs and volume of patients.	A1. % of patients who reported full access	3,357	59.8 (55.1–64.4)
		A2. % of patients who reported partial access	2,144	35.9 (31.7–40.3)
		A3. % of patients who reported no access	257	4.3 (3.0–6.1)
Accessibility	Relationship between location of the service and location of patients, considering resources of users of transportation, travel time, distance, and cost.	B1. % of patients who declared the UBS was far from their house	1,835	24.5 (22.2–27.0)
		B2. % of patients who declared it is very easy/easy getting to the UBS	7,204	83.0 (80.5–85.2)
		B3. % of patients who declared walking to the UBS	5,723	64.5 (60.9–67.9)
		B4. % of patients who rated as very easy/easy the existing signaling to find the dispensing unit of SUS	5,063	91.3 (88.8–93.2)
Accommodation	Represents the relationship between the way the services are organized to receive patients and the ability of patients to adapt to this organization.	C1. % of patients who declared the comfort of the SUS dispensing unit is very good/good	4,053	74.2 (68.0–79.5)
		C2. % of patients who declared the cleanliness of the SUS dispensing unit is very good/good	4,946	90.9 (87.6–93.4)
		C3. Average waiting time in minutes to receive medicines	1,628	32.93 (14.6–51.3)
		C4. % of patients who declared not waiting to withdraw medicines	4,082	70.8 (65.6–75.4)
		C5. % of patients who declared the opening hours of the UBS is very good/good	7,104	85.7 (83.7–87.5)
Acceptability	Represents the attitudes of individuals and providers regarding the characteristics and practices of each one.	D1. % of patients who declared to be always/repeatedly served with respect and courtesy	5,207	93.1 (91,8–94.2)
		D2. % of patients who declared the care performed by the SUS dispensing unit is very good/good	5,039	90.5 (88.7–92.0)
		D3. % of patients who declared the privacy in the care performed by the SUS dispensing unit where they receive medicines is very good/good	3,660	66.4 (61.2–71.0)
Affordability	Relationship between the cost of services and payment capacity of the patient or client.	E1. % of patients who reported the family was not able to buy something important to cover expenses with a health problem	937	13.0 (10.2–16.4)
Affordability		E2. % of patients who declared that medicines were the problem that caused this expense	389	41.8 (33.7–50.0)

	North		Northeast		Midwest		Southeast		South

	n^a	% (95%CI)^b	n^a	% (95%CI)^b	n^a	% (95%CI)^b	n^a	% (95%CI)^b	n^a	% (95%CI)^b
A1. Perception on the access to medicines in SUS										p = 0.167
Total access	561	54.2 (43.6–64.5)	515	57.0 (49.3–64.3)	473	46.3 (40.0–52.4)	777	64.3 (53.4–73.9)	1,031	60.8 (54.2–67.0)
Partial access	407	39.1 (30.7–48.2)	427	36.8 (29.6–44.6)	399	46.6 (40.6–53.0)	468	32.5 (24.0–42.5)	443	36.4 (30.8–42.5)
No access	67	6.7 (3.2–13.2)	52	6.3 (3.1–12.2)	70	7.1 (4.7–10.8)	38	3.2 (2.0–5.1)	30	2.8 (1.6–4.8)
B1. Accessibility – Is the UBS far from the patients’ house?										p = 0.813
Yes	280	20.2 (15.9–25.3)	478	29.6 (23.8–36.1)	314	22.0 (17.8–27.0)	346	21.6 (18.5–25.0)	417	23.9 (20.4–27.8)
More or less	245	16.4 (12.7–20.8)	284	15.6 (12.9–18.7)	247	16.4 (13.0–20.4)	288	16.3 (13.0–20.6)	297	15.7 (12.3–19.8)
No	1,021	63.4 (56.3–70.0)	919	54.8 (47.1–62.3)	953	61.5 (55.6–67.0)	1,196	62.1 (57.0–66.8)	1,306	60.4 (55.5–65.2)
B2. Accessibility – Facility to go to the UBS										p = 0.358
Very easy/easy	1,277	81.5 (77.0–85.3)	1,373	81.9 (76.0–86.7)	1,255	80.3 (76.0–83.8)	1,568	84.6 (80.2–88.0)	1,731	82.9 (79.1–86.2)
Neither easy nor difficult	160	10.5 (8.0–13.8)	158	9.0 (6.4–12.5)	137	11.2 (8.6–14.5)	149	9.4 (7.2–12.1)	139	7.6 (5.9–9.8)
Difficult/very difficult	109	7.9 (5.4–11.5)	150	9.0 (6.3–12.8)	122	8.5 (6.6–10.9)	114	6.1 (4.0–9.2)	149	9.4 (7.2–12.2)
B3. Accessibility – Patients’ means of transport to get to the UBS										p < 0.05
Walking	1,039	60.4 (50.8–69.3)	1,161	66.2 (57.6–74.0)	859	52.6 (48.0–52.6)	1,349	70.1 (64.0–75.6)	1,315	58.4 (53.4–63.3)
Bus^c	75	3.3 (2.3–4.8)	152	4.2 (2.8–6.4)	77	3.5 (1.9–6.2)	165	5.7 (4.3–7.4)	157	7.1 (4.7–10.6)
Car/Motorcycle	341	22.2 (15.7–30.4)	349	27.8 (21.4–35.0)	461	32.8 (28.5–37.0)	355	23.3 (17.5–30.0)	577	34.5 (30.3–38.9)
Boat/Other	123	8.1 (5.7–11.5)	64	4.7 (3.0–7.2)	123	9.5 (7.0–12.8)	37	2.5 (1.5–4.2)	59	3.8 (2.1–6.6)
B4. Accessibility – Existing signaling in the UBS to find the SUS dispensing units										p = 0.024
Very easy/easy	880	86.9 (81.4–90.9)	858	93.3 (90.5–95.3)	820	89.1 (86.0–91.6)	1,143	92.6 (87.6–95.7)	1,362	88.9 (83.3–92.8)
Neither easy nor difficult	96	9.3 (6.2–13.6)	93	5.0 (3.7–6.6)	45	5.5 (3.1–9.6)	70	5.3 (3.1–8.8)	58	4.8 (2.7–8.2)
Difficult/very difficult	48	3.9 (2.3–6.4)	20	1.7 (0.7–4.1)	59	5.4 (3.4–8.3)	41	2.1 (1.1–4.2)	69	6.3 (3.6–11.1)
C1. Accommodation – Comfort of the SUS dispensing unit where the patient receives medicines										p = 0.025
Very good/good	661	64.2 (54.5–72.8)	581	66.7 (52.3–78.5)	685	74.9 (65.9–82.2)	975	82.2 (74.7–87.8)	1,151	73.0 (59.5–83.3)
Neither good nor bad	227	22.2 (16.3–29.4)	183	12.0 (7.9–17.8)	151	15.1 (10.8–20.7)	167	11.3 (8.4–15.0)	188	14.3 (10.2–19.6)
Bad/very bad	143	13.7 (9.5–19.2)	215	21.4 (13.5–32.1)	93	10.0 (6.2–15.7)	130	6.5 (3.6–11.6)	156	12.7 (6.6–22.8)
C2. Accommodation – Cleanliness of the SUS dispensing unit where the patient receives medicines										p = 0.249
Very good/Good	823	82.8 (75.6–88.2)	786	88.3 (78.8–93.9)	802	91.7 (85.1–95.5)	1,161	93.0 (86.1–96.6)	1,374	92.3 (88.2–95.0)
Neither good nor bad	142	14.0 (9.8–19.6)	114	9.5 (4.7–18.3)	59	6.2 (3.6–10.4)	66	5.1 (2.7–9.3)	74	5.7 (3.8–8.4)
Bad/very bad	31	3.2 (1.7–5.8)	28	2.2 (1.1–4.1)	19	2.1 (0.8–5.3)	23	1.9 (0.7–5.2)	24	2.1 (1.0–4.1)
C3. Accommodation – Waiting time in minutes to receive medicines in SUS										p = 0.173
Average	154	13.3 (10.8–15.7)	242	18.2 (11.0–25.1)	179	14.5 (11.6–17.0)	508	59.1 (11.0–107.0)	545	18.1 (11.0–25.1)
C4. Accommodation – Perception of time spent to receive medicines in SUS units										p = 0.008
No time	879	85.6 (78.7–90.5)	738	80.1 (71.6–86.6)	749	77.8 (69.3–84.5)	763	69.2 (57.9–78.5)	953	59.2 (52.6–65.6)
A little	133	12.7 (8.7–18.2)	204	17.9 (12.0–25.8)	151	18.9 (12.7–27.1)	413	24.0 (18.7–30.2)	453	34.3 (26.0–43.6)
A long time	21	1.8 (0.7–4.5)	38	2.0 (0.9–4.4)	28	3.3 (1.8–6.1)	95	6.8 (2.9–15.2)	92	6.6 (2.6–15.7)
C5. Accommodation – Evaluation of the opening hours of the UBS										p = 0.001
Very good/good	1,242	81.8 (76.8–86.0)	1,267	80.5 (74.9–85.1)	1.259	84.8 (79.9–88.7)	1,578	89.8 (87.3–91.8)	1,758	87.5 (84.1–90.2)
Neither good nor bad	203	13.2 (9.8–17.6)	260	12.6 (9.4–16.6)	170	10.8 (7.9–14.6)	165	7.6 (6.2–9.4)	168	8.2 (6.2–10.7)
Bad/very bad	78	4.9 (3.6–6.8)	124	6.9 (5.1–9.3)	77	4.4 (3.1–6.1)	59	2.6 (1.7–3.9)	80	4.3 (2.5–7.4)
D1. Acceptability – Do the staff of the SUS dispensing units attend patients with respect and courtesy?										p = 0.175
Always/repeatedly	921	91.0 (89.4–93.8)	874	91.8 (89.2–93.8)	839	91.9 (89.4–93.8)	1,174	94.8 (93–96.2)	1,399	93.0 (89.9–95.2)
Sometimes	92	7.3 (5.1–10.3)	88	6.7 (4.5–9.9)	74	6.4 (4.6–8.9)	76	3.6 (2.6–5.1)	79	5.4 (3.8–7.5)
Rarely/never	22	1.7 (1.0–2.9)	25	1.5 (0.8–2.7)	23	1.7 (1.1–2.8)	27	1.6 (1.0–2.5)	22	1.6 (0.9–3.2)
D2. Acceptability – Evaluation of the service performed by the SUS dispensing units										p = 0.046
Very good/good	872	85.2 (79.9–89.2)	848	90.6 (88.4–92.4)	806	88.1 (83.7–91.5)	1,161	93.2 (90.7–95.0)	1,352	88.5 (83.5–92.1)
Neither good nor bad	130	12.2 (8.7–16.9)	105	7.4 (6.1–9.0)	95	9.0 (6.3–12.6)	88	5.2 (4.0–6.9)	116	8.9 (6.1–12.7)
Bad/very bad	28	2.6 (1.4–4.9)	33	2.0 (1.3–3.3)	33	2.9 (1.6–5.3)	27	1.6 (0.8–3.2)	31	2.7 (1.6–4.2)
D3. Acceptability – Evaluation of the privacy in the service performed by the SUS dispensing units										p = 0.010
Always/repeatedly	714	69.2 (48.5–64.8)	551	61.8 (52.8–70.0)	520	56.8 (48.5–65.0)	827	73.1 (62–81.6)	1,048	63.7 (56.8–70.0)
Sometimes	131	12 (8.0–17.5)	176	13.8 (10.9–17.0)	165	16.7 (11.8–23.0)	136	11.1 (7.3–16.4)	164	12.6 (9.8–16.0)
Rarely/never	182	18 (9.8–30.7)	168	15.7 (10.0–23.8)	235	24.4 (16.0–35.2)	265	12.8 (8.4–19.0)	263	21.3 (15.4–28.6)
E1. Affordability – Were you not able to buy something important to cover expenses for any health problem?										p = 0.533
Yes	123	7.5 (5.4–10.4)	224	14.7 (10.3–20.6)	148	9.3 (5.4–15.5)	194	12.1 (6.6–21.0)	248	14.5 (9.8–20.8)
No	1,420	92.5 (89.6–94.6)	1,454	85.3 (79.4–89.7)	1,368	90.7 (84.5–94.6)	1,633	87.9 (79.0–93.0)	1,771	85.5 (79.2–90.2)
E 1.2. Affordability – % of patients who declared that medicines were the problem that caused this expense										p = 0.429
Yes	40	27.3 (20.1–36.0)	101	45.6 (35.0–56.7)	67	42.4 (30.0–55.9)	87	45.8 (25.7–67.0)	94	34.1 (25.9–43.0)

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[1] Correspondence: Juliana Álvares, Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais. Rua Silvianópolis, 23 – Santa Tereza, 31010-410. Belo Horizonte, MG, Brasil. Email: jualvares@gmail.com