Access to continued-use medication among older adults, Brazil

Viana, Karynna Pimentel; Brito, Alexandre dos Santos; Rodrigues, Claudia Soares; Luiz, Ronir Raggio

doi:10.1590/S0034-8910.2015049005352

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Sumário

Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005352 copy

Access to continued-use medication among older adults, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To determine the prevalence and associated access factors for all continued-use prescription drugs and the ways in which they can be obtained.

METHODS

Data was obtained from the 2008 Household National Survey. The sample comprised 27,333 individuals above 60 years who reported that they used continued-use prescription drugs. A descriptive analysis and binary and multiple multinomial logistic regressions were performed.

RESULTS

86.0% of the older adults had access to all the medication they needed, and among them, 50.7% purchased said medication. Those who obtained medication from the public health system were younger (60-64 years), did not have health insurance plans, and belonged to the lower income groups. It is remarkable that 14.0% of the subjects still had no access to any continued-use medication, and for those with more than four chronic diseases, this amount reached 22.0%. Those with a greater number of chronic diseases ran a higher risk of not having access to all the medication they needed.

CONCLUSIONS

There are some groups of older adults with an increased risk of not obtaining all the medication they need and of purchasing it. The results of this study are expected to contribute to guide programs and plans for access to medication in Brazil.

Aged; Drug Utilization, economics; Drugs of Continuous Use; Pharmaceutical Preparations, supply & distribution; Population Surveys

Variable	Study population		Free access		Access by purchase		Mixed access		Did not have full access

	n	%	Prevalence %	95%CI	Prevalence %	95%CI	Prevalence %	95%CI	Prevalence %	95%CI
Age range (years)
60 to 64	7,573	27.7	33.6	32.3;34.9	42.7	41.3;44.2	10.6	9.7;11.5	13.1	12.2;14.0
65 to 69	6,453	23.3	34.5	33.2;35.9	40.8	39.3;42.3	10.6	9.7;11.7	14.0	13.0;15.1
70 to 74	5,244	19.2	30.0	28.6;31.5	42.8	41.1;44.5	11.6	10.6;12.8	15.6	14.3;16.9
≥ 75	8,063	29.5	26.9	25.7;28.2	47.0	45.6;48.5	11.9	11.0;12.8	14.1	13.1;15.2
Sex
Masculine	10,373	38.0	32.5	31.0;33.6	43.0	41.8;44.2	10.7	9.9;11.5	13.8	12.9;14.7
Feminine	16,960	62.0	30.4	29.5;31.3	43.9	42.8;44.9	11.5	10.8;12.1	14.3	13.6;15.0
Region
North	1,086	4.0	35.8	33.1;38.7	43.4	40.4;46.4	7.5	6.4;8.9	13.3	11.5;15.2
Northeast	6,118	22.4	39.1	37.3;40.9	39.2	37.4;41.1	10.3	9.2;11.5	11.3	10.3;12.5
Southeast	13,852	50.6	28.0	26.9;29.2	46.1	44.6;47.6	10.5	9.6;11.4	15.4	14.4;16.5
South	4,540	17.0	29.1	27.0;31.3	41.9	39.5;44.2	15.1	13.3;17.1	13.9	12.5;15.5
Midwest	1,647	6.0	31.2	28.9;33.6	43.1	40.5;45.8	11.3	9.7;13.1	14.4	12.5;16.5
Location
Urban	23,583	86.3	29.6	28.7;30.4	45.3	44.3;46.3	10.9	10.2;11.5	14.3	13.6;15.0
Rural	3,750	13.7	41.3	39.0;43.6	32.7	30.4;35.1	13.0	11.3;14.8	13.0	11.5;14.8
Income group
1	2,568	9.4	9.9	8.7;11.2	76.4	74.5;78.3	4.7	4.0;5.6	9.0	7.8;10.3
2	10,848	39.6	26.0	24.9;27.2	49.3	48.0;50.6	11.4	10.5;12.3	13.3	12.5;14.2
3	12,700	46.5	41.9	40.7;43.0	28.9	27.8;30.1	12.9	12.1;13.8	16.3	15.4;17.3
Missing	1,216	4.2
Held a healthcare plan
Yes	9,446	34.6	13.2	12.4;14.1	68.7	67.2;69,9	7.9	7.2;8.7	10.2	9.3;11.1
No	17,887	65.4	40.7	39.7;41.7	30.3	29.3;31.3	12.9	12.1;13.6	16.2	15.4;17.0
Visited a medical professional in the past 12 months
Yes	24,907	91.1	30.9	30.0;31.7	42.9	41.9;43.8	11.7	11.1;12.4	14.5	13.9;15.2
No	2,425	8.9	34.5	32.3;36.8	50.7	48.3;53.1	5.2	4.3;6.3	9.6	8.3;11.1
Normally visits the same healthcare service
Yes	22,014	80.5	32.2	31.3;33.1	42.2	41.2;43.3	11.5	10.8;12.2	14.1	13.4;14.8
No	5,319	19.5	26.9	25.3;28.5	49.0	47.2;50.7	9.9	8.9;10.9	14.3	13.1;15.6
Perceived state of health
Good or very good	9,837	36.0	29.8	28.6;31.1	54.4	53.0;55.8	6.7	6.1;7.3	9.1	8.4;9.9
Normal	12,812	46.9	33.1	32.0;34.1	39.4	38.2;40.6	12.1	11.3;12.9	15.5	14.6;16.4
Bad or very bad	4,668	17.1	28.9	27.3;30.5	32.2	30.5;33.8	18.1	16.7;19.5	20.9	19.5;22.4
Number of morbidities reported
None	1,840	6.7	21.1	19.1;23.3	65.2	62.6;67.7	5.7	4.6;7.1	8.0	6.7;9.5
1	7,821	28.7	36.9	35.6;38.2	46.9	45.5;48.4	6.8	6.2;7.5	9.4	8.6;10.2
3 to 4	12,931	47.3	32.1	31.0;33.2	40.9	39.8;42.1	12.0	11.2;12.9	15.0	14.1;15.8
≥ 4	4,441	17.3	23.2	21.9;24.7	36.7	35.0;38.4	18.1	16.7;19.6	22.0	20.5;23.5

Variable	Purchased all medication				Mixed access				Did not have full access

	OR	95%CI	OR_aj	95%CI	OR	95%CI	OR_aj	95%CI	OR	95%CI	OR_aj	95%CI
Age range (years)
60 to 64	1.0		1.0		1.0		1.0		1.0		1.0
65 to 69	0.9	0.8;1.0	1.0	0.9;1.1	0.9	0.8;1.0	1.0	0.8;1.1	1.0	0.8;1.2	1.0	0.9;1.2
70 to 74	1.1	0.9;1.2	1.2	1.1;1.3	1.2	1.0;1.4	1.2	1.1;1.4	1.4	1.2;1.6	1.3	1.1;1.5
≥ 75	1.3	1.2;1.4	1.5	1.4;1.6	1.4	1.2;1.6	1.4	1.2;1.6	1.3	1.1;1.5	1.3	1.2;1.5
Sex
Feminine	1.1	1.0;1.1	1.1	1.0;1.2	1.1	1.0;1.1	1.1	1.0;1.2	1.1	1.0;1.2	1.1	1.0;1.2
Masculine	1.0		1.0		1.0		1.0		1.0		1.0
Region
North	1.0		1.0		1.0		1.0		1.0		1.0
Northeast	0.9	0.8;1.1	0.8	0.7;1.0	1.4	1.1;1.9	1.3	1.0;1.7	0.9	0.7;1.2	0.8	0.7;1.0
Southeast	1.5	1.2;1.7	0.8	0.7;0.9	1.8	1.4;2.4	1.7	1.3;2.1	1.7	1.3;2.2	1.3	1.1;1.6
South	1.3	1.1;1.6	0.8	0.6;0.9	2.4	1.8;3.3	2.3	1.8;3.0	1.4	1.1;1.9	1.2	1.0;1.5
Midwest	1.2	1.0;1.5	0.8	0.6;1.0	2.0	1.4;2.7	1.6	1.2;2.1	1.5	1.1;2.0	1.1	0.9;1.4
Household location
Urban	1.9	1.6;2.1	0.9	0.8;1.0	1.1	0.9;1.3	0.9	0.8;1.1	1.5	1.3;1.8	1.2	1.0;1.4
Rural	1.0	1.6;2.1	1.0		1.0		1.0		1.0		1.0
Income group
1	21.3	17.5;26.0	5.0	2.5;10.2	2.3	1.7;3.0	1.5	0.5;4.7	3.2	2.5;4.2	2.7	1.0;7.5
2	2.7	2.5;4.2	1.3	1.1;1.7	1.4	1.3;1.6	1.1	0.9;1.4	1.3	1.2;1.5	1.2	0.9;1.6
3	1.0		1.0		1.0		1.0		1.0		1.0
Holds a healthcare plan
Yes	7.8	7.0;8.7	4.3	3.9;4.7	2.0	1.7;2.4	1.7	1.4;1.9	2.1	1.8;2.4	1.5	1.3;1.8
No	1.0		1.0		1.0		1.0		1.0		1.0
Visited a medical professional in the last 12 months
Yes	0.9	0.8;1.0	0.7	0.6;0.8	2.5	2.0;3.1	1.9	1.6;2.4	1.7	1.4;2.0	1.3	1.1;1.3
No	1.0		1.0		1.0		1.0		1.0		1.0
Normally visits the same healthcare service
Yes	0.7	0.6;0.8	0.6	0.6;0.7	0.9	0.8; 1.1	0.8	0.7;1.0	0.8	0.7;0.9	0.7	0.6;0.8
No	1.0		1.0		1.0		1.0		1.0		1.0
Perceived state of health
Good or very good	1.0		1.0		1.0		1.0		1.0		1.0
Normal	0.6	0.6;0.7	1.0	0.9;1.0	1.7	1.5;2.0	1.5	1.3;1.7	1.6	1.4;1.8	1.5	1.3;1.7
Bad or very bad	0.6	0.5;0.7	1.1	1.0;1.2	2.7	2.3;3.2	2.4	2.1;2.8	2.4	2.1;2.7	2.2	1.9;2.5
Number of morbidities reported
None	1.0		1.0		1.0		1.0		1.0		1.0
Only 1	0.4	0.3;0.5	0.5	0.4;0.6	1.1	0.5;1.0	0.7	0.6;0.9	1.3	0.5;0.9	0.7	0.6;0.9
3 to 4	0.4	0.3;0.4	0.5	0.4;0.6	1.1	1.0;2.0	1.2	1.0;1.6	1.3	0.9;1.7	1.2	1.0;1.5
≥ 4	0.5	0.4;0.6	0.6	0.5;0.7	2.8	1.9;4.0	2.1	1.6;2.7	2.7	2.0;3.7	2.0	1.6;2.6

Group	Adjusted odds ratio (OR)

Income group	Full access by purchase		Mixed access		Did not have full access

	Urban	Rural	Urban	Rural	Urban	Rural
Group 1	12.6	5.4	0.3	0.4	0.4	0.9
Group 2	2.5	1.4	0.8	1.0	0.7	1.0
Group 3	1.0	1.0	1.0	1.0	1.0	1.0

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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[1] Correspondence: Karynna Pimentel Viana. Rua Dr. Pereira Nunes, 35 apto 302 Ingá. 24210-420 Niterói, RJ, Brasil. E-mail:karynnaviana@yahoo.com.br