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Original Articles • Rev. Saúde Pública 50 (suppl 2) • 12 Dec 2016 • https://doi.org/10.1590/S1518-8787.2016050006150 copy

Factors associated with low adherence to medicine treatment for chronic diseases in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze factors associated with low adherence to drug treatment for chronic diseases in Brazil.

METHODS

Analysis of data from Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - Brazilian Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based cross-sectional household survey, based on a probabilistic sample of the Brazilian population. We analyzed the association between low adherence to drug treatment measured by the Brief Medication Questionnaire and demographic, socioeconomic, health, care and prescription factors. We used Poisson regression model to estimate crude and adjusted prevalence ratios, their respective 95% confidence interval (95%CI) and p-value (Wald test).

RESULTS

The prevalence of low adherence to drug treatment for chronic diseases was 30.8% (95%CI 28.8-33.0). The highest prevalence of low adherence was associated with individuals: young adults; no education; resident in the Northeast and Midwest Regions of Brazil; paying part of the treatment; poor self-perceived health; three or more diseases; reported limitations caused by a chronic disease; using five drugs or more.

CONCLUSIONS

Low adherence to drug treatment for chronic diseases in Brazil is relevant, and regional and demographic differences and those related to patients’ health care and therapy regime require coordinated action between health professionals, researchers, managers and policy makers.

Patient Dropouts; Medication Adherence; Drugs of Continuous Use; Chronic Disease; Health Services Accessibility; Socioeconomic Factors; Health Surveys

BMQ^a	%^b	95%CI
Categorical score
Adherence	2.6	2.1–3.2
Likely adherence	66.6	64.4–68.7
Likely low adherence	17.0	15.5–18.6
Low adherence	13.8	12.7–15.1
Dichotomous BMQ score
Adherence or likely adherence	69.2	67.0–71.2
Likely low adherence or low adherence	30.8	28.8–33.0

Variable	Breakdown in sample		Prevalence of low adherence^c

	%^a	95%IC	%^a	95%IC
Demographic characteristics
Gender
Male	35.3	33.9–36.7	28.3	25.4–31.5
Female	64.7	63.3–66.1	32.1	29.9–34.4
Age (years)
20-39	15.0	13.6–16.6	38.6	33.1–44.5
40-59	42.8	41.1–44.4	30.3	27.8–33.0
≥ 60	42.2	40.4–44.0	28.7	26.5–31.0
Skin color
White	50.6	47.8–53.4	30.0	27.3–32.8
Non-white	49.4	46.6–52.2	31.4	28.9–34.0
Marital status
With partner	61.4	59.8–62.9	30.5	28.3–32.8
Without partner	38.6	37.1–40.2	31.6	28.9–34.5
Socioeconomic characteristics
Level of education (years of study)
No education	15.0	13.7–16.4	35.5	31.5–39.8
1 to 8 years	43.1	41.2–45.0	28.5	25.8–31.3
≥ 8 years	41.8	40.0–43.7	31.7	29.3–34.2
Economic status ABEP^d
A/B	24.6	22.3–27.0	30.6	26.9–34.6
C	54.8	52.9–56.7	30.3	28.0–32.7
D/E	20.7	18.9–22.5	32.6	29.2–36.2
Brazilian region
North	4.2	3.2–5.3	22.7	18.8–27.1
Northeast	20.6	16.8–25.0	38.1	35.1–41.2
Southeast	51.9	46.0–57.8	29.2	25.7–33.0
South	15.7	12.7–19.3	26.8	24.5–29.2
Midwest	7.7	6.0–9.8	35.5	31.6–39.6
Health plan
Yes	28.4	26.0–31.0	29.0	26.1–32.1
No	71.6	69.0–74.0	31.6	29.3–34.0

Total			30.8	28.8–33.0

Variable	Sample breakdown		Prevalence of low adherence

	%	95%IC	%	95%IC
Health system characteristics
Visits doctor to treat chronic diseases
Yes	93.3	92.3–94.2	31.2	29.0–33.5
No	6.7	5.8–7.7	32.3	27.9–37.0
Number of doctors visited to treat chronic diseases
One	68.2	66.3–70.0	27.2	24.9–29.6
More than one	31.8	30.0–33.7	40.1	37.2–43.2
Free access to chronic drug therapy for chronic diseases
All free	46.9	44.5–49.2	25.4	23.0–28.1
Any free	20.3	19.1–21.5	46.6	42.7–50.7
None free	32.9	30.8–35.1	29.0	26.5–31.7
Number of hospitalizations in the previous 12 months
None	89.1	88.2–90.0	29.8	27.7–32.1
1	8.2	7.5–9.0	34.6	29.8–39.8
2 or more	2.7	2.2–3.2	51.8	42.7–60.9
Number of emergency visits in the previous 12 months
None	77.0	75.3–78.6	27.1	25.0–29.3
1	14.9	13.8–16.0	39.8	36.2–43.7
2 or more	8.1	7.2–9.1	50.0	44.6–55.4
Self-perceived health and morbidities
Self-perceived health
Very good	5.1	4.4–5.9	17.2	11.4–25.1
Good	45.6	43.6–47.6	25.0	22.6–27.7
Average	40.8	39.1–42.4	35.9	33.4–38.5
Poor	6.3	5.6–7.0	46.4	41.1–51.7
Very poor	2.3	1.9–2.7	49.6	39.7–59.5
Number of chronic diseases (comorbidities)
1	44.8	42.9–46.7	20.9	18.8–23.1
2	27.2	26.1–28.4	33.3	30.6–36.1
3 or more	28.0	26.3–29.7	44.2	41.0–47.4
Limitations due to chronic disease
No limitations	48.5	46.7–50.3	21.9	19.9–24.1
Limitations	51.5	49.7–53.3	39.5	36.9–42.2
Use of drugs
Number of drugs used (continuous or occasional)
1	34.6	33.2–36.0	20.6	18.2–23.2
2	26.0	24.7–27.3	26.4	23.8–29.2
3 to 4	26.0	24.8–27.3	38.9	35.6–42.4
5 or more	13.4	12.5–14.4	50.1	46.4–53.8

Total			30.8	28.8–33.0

Variable^c	Crude analysis			Adjusted analysis

	PR	95%IC	p^d	PR	95% IC	P^d
Level 1
Demographic characteristics
Gender			0.017
Male	Ref
Female	1.13	1.02–1.25
Age (years)			< 0.001			< 0.001
20-39	1.34	1.16–1.56		1.64	1.39-1.93
40-59	1.05	0.95–1.16		1.16	1.04-1.29
≥ 60	Ref
Skin color			0.383
White	Ref
Non-white	1.04	0.94–1.16
Marital status			0.409
With partner	Ref
Without partner	1.03	0.95–1.12
Socioeconomic characteristics
Level of education (years of study)			0.003
No education	1.11	0.97–1.27
1 to 8 years	0.89	0.81–0.99
≥ 8 years	Ref
Economic status ABEP^d			0.372
A/B	Ref
C	0.98	0.86–1.12
D/E	1.06	0.90–1.25
Brazilian region			< 0.001			< 0.001
North	Ref
Northeast	1.68	1.37–2.05		1.33	1.10-1.61
Southeast	1.28	1.03–1.61		1.11	0.90-1.38
South	1.18	0.96–1.44		0.98	0.81-1.18
Midwest	1.56	1.26–1.94		1.21	1.00-1.47
Health plan			0.102			0.031
Yes	0.91	0.82–1.01		0.89	0.81-0.99
No	Ref

Level 2

Health system characteristics
Visits doctor to treat chronic diseases			0,668
Yes	Ref
No	0.96	0.82–1.12
Number of doctors visited to treat chronic diseases			< 0.001			< 0.001
One	Ref
More than one	1.47	1.34–1.61		1.16	1.06-1.26
Free access to drug therapy for chronic diseases			< 0.001			< 0.001
All free	Ref
Any free	1.83	1.64–2.04		1.32	1.18-1.49
None free	1.14	1.01–1.28		1.14	1.02-1.29
Number of hospitalizations in the previous 12 months			< 0.001
None	Ref
1	1.15	0.99–1.34
2 or more	1.73	1.44–2.08
Number of emergency visits in the previous 12 months			< 0.001			< 0.001
None	Ref
1	1.47	1.32–1.63		1.14	1.03-1.27
2 or more	1.84	1.63–2.09		1.32	1.18-1.48
Self-perceived health and morbidities
Self-perceived health			< 0.001
Very good	Ref
Good	1.45	0.99–2.12
Average	2.08	1.40–3.08
Poor	2.69	1.78–4.07
Very poor	2.88	1.91–4.32
Number of chronic diseases (comorbidities)			< 0.001			< 0.001
1	Ref
2	1.59	1.41–1.79		1.28	1.10-1.48
3 or more	2.11	1.88–2.31		1.39	1.16-1.66
Limitations due to chronic disease			< 0.001			< 0.001
No limitations	Ref
Limitations	1.80	1.64–1.97		1.34	1.21-1.49

Level 3

Use of drugs
Number of drugs used to treat chronic diseases			< 0,001			< 0,001
1	Ref
2	1,28	1,12–1,46		1,08	0,93–1,26
3 to 4	1,89	1,67–2,12		1,43	1,21–1,69
5 or more	2,43	2,14–2,76		1,61	1,34–1,94

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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