Consumption and Lack of Access to Medicines and Associated Factors in the Brazilian Amazon: A Cross-Sectional Study, 2019

Abstract

Objective We aimed to investigate the consumption and lack of access to medicines in the adult population of Manaus, Amazonas. Methods A population-based study was conducted in Manaus in 2019. Individuals aged ≥18 years were selected by probabilistic sampling performed in three stages. Study outcomes included the consumption of medicines in the previous fortnight and the lack of access to treatments in those who used any medicine. We calculated the prevalence ratios (PR) for the outcomes with 95% confidence intervals (CI) by Poisson regression with robust variance, considering the complex sampling design. Results Out of the 2,321 participants, 53.2% (95%CI 50.7-55.7%) consumed medicines, of which 14.4% (95% CI 11.9–16.8%) could not obtain appropriate treatments. Analgesics were the most used medicines (557/2,702; 21.4%), whereas antibiotics were the most inaccessible treatments (18/228; 7.9%). Lack of financial resources was the main reason for not accessing treatments (104/228; 45.6%). Consumption was significantly associated with older age (≥60 years: PR = 1.27; 95%CI 1.09–1.49), lower social class (D/E: PR = 0.84; 95%CI 0.72–0.99), lower educational level (p = 0.039), poor health status (PR = 1.30; 95%CI 1.11–1.52), use of health care services (PR = 1.37; 95%CI 1.26–1.49), and chronic diseases (PR = 1.36; 95%CI 1.22–1.52). Lack of access was higher in people with poor health status (PR = 2.46; 95%CI 1.50–4.04) and chronic diseases (PR = 1.84; 95%CI 1.16–2.92). Conclusion Half of Manaus’ population used medicines, which was higher in socially privileged and sicker individuals. Among those, 14 in every 100 could not access drug therapies, which was more frequent in people with poor health and with chronic diseases.

Prevalência e fatores associados à polifarmácia e potenciais interações medicamentosas em adultos na cidade de Manaus: estudo transversal de base populacional, 2019

“…20 Além das discrepâncias nas representatividades e entre os contextos dos estudos, dificuldades no uso e acesso a serviços de saúde e medicamentos na região Norte podem explicar essas diferenças, especialmente entre indivíduos socialmente desfavorecidos e vulneráveis. 21,22 Regiões financeiramente mais privilegiadas tendem a oferecer maior acesso a serviços de saúde, incluindo medicamentos, o que resulta em um possível aumento no número de prescrições. 19 A prevalência de polifarmácia foi três vezes maior entre os idosos do que nos adultos em geral (incluindo idosos).…”

“…20 In addition to discrepancies in the representativeness and the contexts of the studies, difficulties in the use and access to health services and medications in the North region may explain these differences, especially among socially disadvantaged and vulnerable individuals. 21 , 22 Economically advantaged regions tend to offer greater access to health services, including medications, resulting in a possible increase in the number of prescriptions. 19 …”

Do Drug Accessibility and OOP Burden Affect Health-Related Quality of Life of Patients With Chronic Diseases? — EQ-5D-5L Evaluation Evidence From Five Districts in China

“…Due to the fragility of social status, patients with chronic diseases are usually in the most disadvantaged position in terms of access to medicines, which will directly affect their health and medicine welfare effects ( 38 ). There are 14 out of every 100 cases in the Manaus population without access to medication, which is more common in people with poor health and chronic diseases ( 39 ). Based on this, this study explores the relationship between drug accessibility and HRQoL of patients with chronic diseases, and finds that the increase in the accessibility of medicines has significant positive impact on the health utility value of patients with chronic diseases.…”

Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

“…Manaus concentrates approximately 93% of the physicians from the state of Amazonas, with a density of 2.15 doctors for each 1,000 inhabitants in 2017 19 . Social and economic inequities in the use of health services, and in the consumption and access to medicines characterize the region 20,21 . Historically, the Brazilian Amazon is a region with noteworthy poor health indicators; problems faced by its inhabitants include low income, hazardous work conditions, high violence rates, increased exposure to infectious diseases, lack of household sanitation, and limited access to health services 9 .…”