Primary non-adherence in Portugal: findings and implications

Abstract

Background Portugal is currently facing a serious economic and financial crisis, which is dictating some important changes in the health care sector. Some of these measures may potentially influence patients' access to medication and consequently adherence, which will ultimately impact on health status, especially in chronic patients. Aims This study aimed at providing a snapshot of adherence in patients with chronic conditions in Portugal between March and April 2012. Setting Community pharmacy in Portugal. Method A cross-sectional pilot study was undertaken, where patients were recruited via community pharmacies to a questionnaire study evaluating the number of prescribed and purchased drugs and, when these figures were inconsistent, the reasons for this. Main outcome measures Primary and secondary adherence measures. Failing to purchase prescription items was categorized as primary nonadherence. Secondary nonadherence was attributed to purchasing prescription items, but not taking medicines as prescribed. Results Data were collected from 375 patients. Primary nonadherence was identified in 22.8 % of patients. Regardless of the underlying condition, the most commonly reported reason for primary non-adherence was having spare medicines at home (''leftovers''), followed by financial problems. The latter appeared to be related to the class of medicines prescribed. Primary nonadherence was associated with low income (\475 €/month; p = 0.026). Secondary non-adherence, assessed by the 7-MMAS was detected in over 50 % of all patients, where unintentional nonadherence was higher than intentional nonadherence across all disease conditions. Conclusion This study revealed that more than one fifth of chronic medication users report primary nonadherence (22.8 %)A very short-version of this work was included in the Annual Report 2012 of the Portuguese Observatory of Health Systems. and more than 50 % report secondary nonadherence. Data indicates that the existence of spare medicines and financial constraints occurred were the two most frequent reasons cited for nonadherence (47, 6-64, 8 and 19-45.5 %, depending on the major underlying condition, respectively). Electronic supplementary material

Adesão À Farmacoterapia, Que Universo É Esse? Uma Revisão Narrativa

“…A não-adesão secundária diz respeito aos medicamentos não administrados conforme prescritos quando a pessoa já aviou o receituário 51,56 . Sendo assim, a não-adesão secundária está relacionada ao atual comportamento do uso do medicamento, uma vez que o mesmo já foi adquirido 55 . Enquanto já se tem conhecimento das consequências de uma não-adesão secundária, pouco se sabe sobre a não-adesão primária.…”

Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal

“…A 2012 patient survey, which included 375 patients sought to provide a snapshot of medication adherence in patients with chronic conditions, found that 22.8% of patients did not purchase prescribed medication, with financial problems cited as one of the main reasons [20]. Another study linked pharmaceutical policy interventions such as harmonizing reimbursement levels and campaigns to promote generics, to utilisation of antipsychotic drugs, found an increase in the use of generic medicines, but also to a decrease in overall sales, consistent with reduced access to medicines [21].…”

Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal

“…Sample size estimated considered 2 million elderly [12], prevalence of 50% non-adherence to chronic medication [27], assumed normal distribution, a 3% error estimate (d) and 95% confidence level and was targeted at 1067 patients.…”

“…Based on previous research, one anticipated a low participation rate of pharmacies [27]. Therefore, a convenience sample of pharmacies (n = 78) was approached, requesting higher input from them in patient recruitment.…”

“…Adherence to chronic medication has been identified as the most problematic type of medicine taking behaviour. In Portugal primary non-adherence (not purchasing a prescribed medicine) may occur in 25% of pharmacy users, but rising above 50% when looking at secondary non-adherence (not taking a prescribed and purchased medicine) [27].…”