Medicine access and utilization in a population covered by primary health care in Brazil

Bertoldi, Andréa Dâmaso; Barros, Aluísio J D; Wagner, Anita K.; Ross‐Degnan, Dennis; Hallal, Pedro Curi

doi:10.1016/j.healthpol.2008.07.001

Cited by 72 publications

(90 citation statements)

References 17 publications

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“…In adults socioeconomic condition is a major determinant of medicine use and many times it outweighs the actual need with a higher To be continued use seen among better-off individuals. 2,11,19 In our study, socioeconomic condition did not affect medicine use at any of the follow-up times. Although socioeconomic condition was associated to the outcome in the crude analysis, after controlling for confounders the effect was no longer observed, probably due to maternal education level and skin color.…”

Section: Discussionmentioning

confidence: 41%

Factors associated to medicine use among children from the 2004 Pelotas Birth Cohort (Brazil)

Oliveira

Bertoldi

Domingues³

et al. 2012

Rev. Saúde Pública

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OBJECTIVE: To identify factors associated to medicine use among children from the 2004 Pelotas Birth Cohort, Brazil. METHODS: Prospective study to evaluate medicine use in children aged 3, 12 and 24 months regardless of the reasons, therapeutic indication or class. The study included 3,985 children followed up at three months of age, 3,907 at 12 months, and 3,868 at the last follow-up time of 24 months. Mothers were interviewed to collect information on medicine use during the recall period of 15 days prior to the interview. The outcome was studied according to sociodemographic and perinatal variables, mother's perception of child's health and breastfeeding status. Crude and adjusted analyses were performed by Poisson regression following a hierarchical model. RESULTS: The prevalence of medicine use ranged from 55% to 65% in the three follow-ups. After controlling for confounders, some variables remained associated to medicine use only at the three-month follow-up with greatest use among children of younger mothers, those children who had intrapartum complications, low birthweight, were never breastfed and were admitted to a hospital. Greatest medicine use was also associated with being a firstborn child at 3 and 12 months; mother's perception of their child health as fair or poor and children whose mothers have private health insurance at 12 and 24 months; highest maternal education level at all follow-up times. CONCLUSIONS: Different variables influence medicine use among children during the first two years of life and they change as the child ages especially maternal factors and those associated to the child's health problems.

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Section: Discussionmentioning

confidence: 41%

Factors associated to medicine use among children from the 2004 Pelotas Birth Cohort (Brazil)

Oliveira

Bertoldi

Domingues³

et al. 2012

Rev. Saúde Pública

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“…The National Strategy for the Reorganization of Arterial Hypertension and Diabetes Mellitus Care implements, through this Program, the register and follow-up of hypertensive and diabetic patients detected by SUS and the free supply of five essential medicines: captopril 25mg, hydroclorotiazide 25mg and propranolol 40mg for hypertension treatment; glibenclamide 5mg and metformin 850mg for diabetes treatment, as well as NPH-100 insulin systematically distributed within the public health service 13 through the Program of Strategic Medicines 14 . National publications about household-level medicine access are scant, the methodologies employed vary, access is measured regardless of consumption conditions 15,16,17,18 and some studies exclude chronic patients 14 . Other studies have evaluated medicine access based on the availability of medicine in health services 2,3,4,5,19 .…”

Section: Introductionmentioning

confidence: 99%

“…Other studies have evaluated medicine access based on the availability of medicine in health services 2,3,4,5,19 . In spite of different methods, population studies using 15-day recall period report medicine access ranging from 87% to 96% 14,15,16 . A study among elderly people from São Paulo city, Brazil, found a slightly lower access -82.7% -during the previous year 17 .…”

Section: Introductionmentioning

confidence: 99%

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Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed

et al. 2010

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The study evaluated free access to hypertension and diabetes medicines and the reasons reported for lack of access. The sample included 4,003 elderly people living in Primary Care Unit coverage areas from 41 Southern and Northeastern Brazilian cities. Free access was higher in the Northeast (62.4%). The strategy of the Family Health Program (Programa Saúde da Família - PSF) was more effective in providing access than the traditional model, with higher results in the Northeast (61.2%) than in the South (39.6%). Around 20% of medicines included in the Hypertension and Diabetes Program and 26% of those included in the National Essential Medicines List (RENAME) were paid out of pocket. In the Northeast, 25% of insulin and 32% of oral antidiabetics were paid out of pocket. Unavailability in the public sector and a lack of money determined the lack of access. Although the PSF, Hypertension and Diabetes Program and RENAME expanded free access, supplies were insufficient. A greater connection between programs and a clear definition of responsibilities can improve medicine acquisition process, increasing the effectiveness of pharmaceutical assistance.

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“…These data indicate that, also in early childhood, the fi rst option when purchasing medicine is out-of-pocket expenditure, as reported by other studies on access to medicines and related costs in Brazil. 5,18 Continuous medicine use decreased with age, from 30.7% at three months to 14.2% at 24 months. Even so, continuous use at three months was 50% higher than that found in a prior cohort, in which uninterrupted use for one month or longer was found to occur in 20% of children.…”

Section: Discussionmentioning

confidence: 99%

Uso de medicamentos do nascimento aos dois anos: Coorte de Nascimentos de Pelotas, RS, 2004

Oliveira

Bertoldi

Domingues³

et al. 2010

Rev. Saúde Pública

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OBJETIVO: Descrever a utilização de medicamentos em crianças aos três, 12 e 24 meses de idade. MÉTODOS: Estudo transversal utilizando dados da Coorte de Nascimentos de Pelotas, RS, de 2004. Foram incluídas 3.985 crianças aos três meses, 3.907 aos 12 meses e 3.868 aos 24 meses de idade. O desfecho considerado foi o uso de medicamentos pelas crianças nos 15 dias anteriores à entrevista. Informações sobre as variáveis independentes (medicamentos utilizados, fonte de indicação, forma de aquisição, regularidade do uso e grupos terapêuticos) foram coletadas por meio de questionário padronizado, em entrevista aos pais nos domicílios. RESULTADOS: As prevalências de uso de medicamentos aos três, 12 e 24 meses foram de 65,0% (IC 95%: 63,5;66,5), 64,4% (IC 95%: 62,9;65,9) e 54,7% (IC 95%: 53,1;56,2), respectivamente. Com o avanço da idade observou-se diminuição no número total de medicamentos utilizados e aumento na automedicação, essa última chegando a 34% aos 24 meses. Também, a freqüência do uso de medicamentos em caráter eventual aumentou e diminuiu a de uso contínuo. Os medicamentos foram adquiridos principalmente com recursos próprios e cerca de 10% foi adquirido pelo Sistema Único de Saúde. Observou-se mudança no perfil dos grupos terapêuticos mais utilizados em função da idade. Aos três meses, o maior uso foi de medicamentos dermatológicos (36%); aos 12 meses, de medicamentos para o sistema respiratório (24%); e, aos 24 meses, de analgésicos (26%). Comparando-se o uso aos 24 meses com o dos três meses de idade observou-se diminuição na utilização de: medicamentos destinados ao trato alimentar e metabolismo, aos órgãos dos sentidos, sistema cardiovascular e produtos dermatológicos. Houve aumento na utilização de: medicamentos anti-infecciosos sistêmicos, destinados ao sistema musculoesquelético, ao sistema respiratório, analgésicos, antiparasitários, inseticidas e repelentes. CONCLUSÕES: A utilização de medicamentos nesta coorte foi elevada e remete à necessidade de priorização do uso racional de medicamentos nos primeiros anos de vida.

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Medicine access and utilization in a population covered by primary health care in Brazil

Cited by 72 publications

References 17 publications

Factors associated to medicine use among children from the 2004 Pelotas Birth Cohort (Brazil)

Factors associated to medicine use among children from the 2004 Pelotas Birth Cohort (Brazil)

Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed

Uso de medicamentos do nascimento aos dois anos: Coorte de Nascimentos de Pelotas, RS, 2004

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