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Original Articles • Rev. Saúde Pública 50 (suppl 2) • 12 Dec 2016 • https://doi.org/10.1590/S1518-8787.2016050006156 copy

National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM): household survey component methods

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To describe methodological aspects of the household survey National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM) related to sampling design and implementation, the actual obtained sample, instruments and fieldwork.

METHODS

A cross-sectional, population-based study with probability sampling in three stages of the population living in households located in Brazilian urban areas. Fieldwork was carried out between September 2013 and February 2014. The data collection instrument included questions related to: information about households, residents and respondents; chronic diseases and medicines used; use of health services; acute diseases and events treated with drugs; use of contraceptives; use of pharmacy services; behaviors that may affect drug use; package inserts and packaging; lifestyle and health insurance.

RESULTS

In total, 41,433 interviews were carried out in 20,404 households and 576 urban clusters corresponding to 586 census tracts distributed in the five Brazilian regions, according to eight domains defined by age and gender.

CONCLUSIONS

The results of the survey may be used as a baseline for future studies aiming to assess the impact of government action on drug access and use. For local studies using a compatible method, PNAUM may serve as a reference point to evaluate variations in space and population. With a comprehensive evaluation of drug-related aspects, PNAUM is a major source of data for a variety of analyses to be carried out both at academic and government level.

Drug Utilization, statistics & numerical data; Pharmaceutical Services, supply & distribution; Sampling Studies; Health Surveys, methods

Block		Section	Aged 15 or over	Incapable of answering interview	Aged below 15
1	Respondent information	Gender Age Level of education Marital status Skin color/ethnicity Self-reported height and weight	✓	Data of substitute respondent: gender, age, level of education and kinship to participant	Data of substitute respondent: gender, age, level of education and kinship to participant
2	Chronic diseases	High blood pressure Diabetes Heart diseases Hypercholesterolemia Stroke Pulmonary disease Arthritis, arthrosis or rheumatism Depression Other chronic diseases lasting 6 months or longer	✓	✓	Respiratory diseases Diabetes Other chronic diseases lasting 6 months or longer
2.1	List of medications for chronic diseases	Detailed description of medications used for chronic diseases	✓	✓	✓
3	Health Services	Use of health services Information on medical care	✓	✓	✓
4	Acute diseases or events treated with medicines	Infection Sleeping or anxiety problems Stomach or bowel problems Flu Cold or rhinitis Fever and pain Use of vitamins, mineral supplements, appetite stimulants or tonics	✓	✓	Nausea, vomiting and diarrhea were included and sleeping or anxiety problems were excluded
4.1	List of medications for acute diseases and events	Detailed description of medications used for acute diseases and events	✓	✓	✓
5	Contraceptives	Oral or injectable contraceptives	✓	✓	✓
6	Pharmacy services	SUS pharmacy Private sector pharmacy Popular pharmacy	✓	✓	✓
7	Behaviors that may affect drug use	People or other sources of reference for indication of drugs Sources of information on drugs Behaviors related to self-medication and non-adherence Guidance on drug storage Guidance on drug use length of time	✓
8	Inserts and packaging	Use of inserts Understanding of inserts	✓
9	Lifestyle	Physical activity Smoking Alcohol consumption	✓
10	Health insurance	Health insurance Insurance coverage	✓	✓	✓
11	Household and head of household information	Household information Head of household information	✓	✓	✓

Region/Age and gender domain		% households not visited	Response rate/household	Response rate/individual	Overall response rate
Region	North	12.4	58.8	95.3	56.1
	Northeast	17.5	53.6	95.3	50.1
	Southeast	10.1	58.1	91.2	53.0
	South	17.6	53.5	93.1	49.8
	Midwest	34.4	42.4	91.5	38.8
Domain: (age group, gender)	0 to 4	18.1	52.8	95.2	50.2
	5 to 19	16.6	60.5	82.8	50.1
	20 to 39, male	16.7	58.8	84.0	49.3
	20 to 39, female	19.6	55.1	96.9	53.4
	40 to 59, male	19.1	55.1	93.6	51.6
	40 to 59, female	18.9	54.1	96.7	52.3
	≥ 60, male	18.1	51.7	90.1	46.6
	≥ 60, female	18.1	51.5	93.7	48.3

Domain (age group, gender)	Measurements	Region

		North	Northeast	Southeast	South	Midwest
0 to 4	Correlation	-0.14	-0.21	-0.17	-0.23	-0.29
0 to 4	p	0.13	0.03	0.09	0.02	< 0.01
5 to 19	Correlation	-0.02	-0.10	-0.06	−0.24	-0.33
5 to 19	p	0.86	0.31	0.58	0.02	< 0.01
20 to 39, male	Correlation	-0.10	-0.09	-0.23	-0.28	-0.16
20 to 39, male	p	0.31	0.40	0.02	0.01	0.17
20 to 39, female	Correlation	-0.21	-0.28	-0.20	-0.36	-0.29
20 to 39, female	p	0.02	< 0.01	0.04	< 0.01	< 0.01
40 to 59, male	Correlation	-0.14	-0.28	-0.18	-0.31	-0.26
40 to 59, male	p	0.13	< 0.01	0.05	< 0.01	0.01
40 to 59, female	Correlation	-0.21	-0.32	-0.30	-0.24	-0.22
40 to 59, female	p	0.02	< 0.01	< 0.01	0.01	0.03
60 or over, male	Correlation	-0.19	-0.32	-0.19	-0.22	-0.35
60 or over, male	p	0.04	< 0.01	0.05	0.02	< 0.01
60 or over, female	Correlation	-0.18	-0.32	-0.25	-0.39	-0.34
60 or over, female	p	0.05	< 0.01	0.01	< 0.01	< 0.01

Region	Domain*								Total
	Age (years) and gender

	0-4	5-19	20-39	20-39	40-59	40-59	≥ 60	≥ 60
	MF	MF	M	F	M	F	M	F
North	1.835	667	552	2.538	1.539	1.778	899	1.115	10.923
Northeast	1.267	618	454	1.881	991	1.521	794	1.268	8.794
Southeast	817	606	533	1.363	1.059	1.267	728	1.125	7.498
South	872	877	562	1.365	1.078	1.299	784	1.009	7.846
Midwest	989	537	336	1.281	839	1.093	554	743	6.372

Total	5.780	3.305	2.437	8.428	5.506	6.958	3.759	5.260

Variable	Category	%^a	95%CI
Age group (years)	0-4	6.2	5.9–6.5
	5-10	9.1	8.3–9.8
	11-19	14.4	13.3–15.5
	20-39	31.9	30.4–33.3
	40-59	25.3	24.3–26.4
	≥ 60	13.2	12.4–14.0
Gender	Male	47.2	46.3–48.1
Gender	Female	52.8	51.9–53.7
Skin color or ethnicity (self-reported)	White	46.0	43.5–48.6
	Black	8.7	7.9–9.7
	Mulatto	43.8	41.5–46.1
	Yellow	1.1	0.9–1.3
	Indigenous	0.4	0.3–0.5
Level of education^b	0-3 years	36.1	34.5–37.7
	4-11 years	31.9	30.8–33.0
	≥ 12 years	32.0	30.6–33.5
Marital status^b	Partner	60.7	59.4–62.1
Marital status^b	No partner	39.3	37.9–40.6
CCEB^c	A	0.5	0.3–0.9
	B	21.9	20.0–23.9
	C	55.3	53.7–57.0
	D	17.7	16.1–19.5
	E	4.6	4.0–5.3
Region	North	7.5	5.9–9.5
	Northeast	24.3	20.1–29.1
	Southeast	45.9	40.0–52.0
	South	14.3	11.5–17.8
	Midwest	7.9	6.2–10.0

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