Health  Vol.7 No.11 , November 2015
Dimensions of Access to Antihypertensive Medications in Ceilândia, Distrito Federal, Brazil
ABSTRACT
Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing indicators to evaluate the dimensions of access to antihypertensive medications in Ceilandia, DF, Brazil. This was a cross-sectional epidemiological study, administering questionnaires during home visits. The survey covered epidemiological and socioeconomic profiles, behavioral habits and the dimensions of access to antihypertensive medications comprising physical, financial, and geographic availability and accept ability according to the hypertensive population of Ceilandia. The total sample comprised 400 individuals and the hypertensive subset numbered 140 (35%). Indicators of physical availability of medications revealed that users found it difficult to acquire their drugs on almost one third of occasions and in some cases were unable to access any of these products. The greatest barriers to access were reported by users of pharmacies belonging to the Brazilian National Health Service (SUS) and on the “People’s Pharmacies” network. More than one third of the hypertensive sample spent their own money on medications they could not find at these pharmacies. The majority of the hypertensive subsets were overweight/obese, a minority engaged in physical activity and 40% were smokers/ex-smokers. More women reduced their salt intake. Men had higher incomes, educational level, and socioeconomic status. Failure to keep the public health care system supplied has prejudiced access to essential medications for hypertension treatment, transferring the costs onto users. This population has life habits that increase the risk of exacerbation of hypertension. These results reveal a need for effective public policies to ensure access to antihypertensive medications and involve users of the health care system in changing their habits and behaviors in order to achieve adequate and lasting control of systemic arterial hypertension.

Cite this paper
Salgado, F. , Galato, D. , de Melo, G. , Chiarello, M. , Oliveira, A. , Gerlack, L. , de Azevedo Meiners, M. and de Oliveira Karnikowski, M. (2015) Dimensions of Access to Antihypertensive Medications in Ceilândia, Distrito Federal, Brazil. Health, 7, 1517-1526. doi: 10.4236/health.2015.711165.
References
[1]   Williams, B. (2009) The Year in Hypertension. Journal of the American College of Cardiology, 55, 65-73.
http://dx.doi.org/10.1016/j.jacc.2009.08.037

[2]   Cesarino C.B., Cipullo J.P., Martin J.F.V., et al. (2008) Prevalence and Sociodemographic Factors in a Hypertensive Population in Sao José do Rio Preto, Sao Paulo, Brazil. Arquivos Brasileiros de Cardiologia, 91, 31-35.

[3]   Rosário T.M., Scala L.C.N.S., Franca G.V.A., Pereira M.R.G. and Jardim P.C.B.V. (2009) Prevalência, controle e tratamento da hipertensao arterial sistêmica em Nobres. Arquivos Brasileiros de Cardiologia, 93, 672-678.

[4]   Andrade, J.P. and Nobre, F. (2010) VI Diretrizes Brasileiras de Hipertensao. Arquivos Brasileiros de Cardiologia, 95, 1-51.

[5]   National Institute of Health (2012) 2012 NHLBI Morbidity and Mortality Chart Book.
http://www.nhlbi.nih.gov/resources/docs/cht-book.htm

[6]   Leonel, R.B. (2010) Subsídios para a compreensao do acesso a medicamentos no Brasil. Monograph, Centro Universitário de Brasília, Brasília.

[7]   Leyva-Flores, R., Erviti-Erice, J., Kageyama-Escobar, M.L. and Arredondo, A. (1998) Prescripcion, acceso y gasto en medicamentos entre usuarios de servicios de salud en México. Salud Publica de Mexico, 40, 24-31.

[8]   Lora A.P. (2004) Acessibilidade aos servicos de saúde: Estudo sobre o tema no enfoque da saúde da família no Município de Pedreira, Sao Paulo. Dissertation, Monograph, Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Campinas.

[9]   Penchansky, R. and Thomas, J.W. (1981) The Concept of Access: Definition and Relationship to Consumer Satisfaction. Medical Care, 19, 127-140.

[10]   Companhia de Planejamento do Distrito Federal (CODEPLAN) (2014) Pesquisa Distrital por Amostra de Domicílios— Distrito Federal—PDAD/DF 2013.
http://www.codeplan.df.gov.br/images/CODEPLAN/PDF/pesquisa_socioeconomica/pdad/2013/Pesquisa%20PDAD-DF%202013.pdf

[11]   Brasil. Censo 2010 (2010) Cadastro Nacional de enderecos para fins estatísticos.
http://www.censo2010.ibge.gov.br/cnefe/

[12]   World Health Organization (WHO); HU(Harvard University—WHO Collaborating Center on Pharmaceutical Policies) (2007) Manual for the Household Survey to Measure Access and Use of Medicines. WHO, Geneva.

[13]   World Health Organization (1998) Obesity—Presenting and Managing the Global Epidemic. Report of a WHO Consultation on Obesity, WHO, Geneve.

[14]   Associacao Brasileira de Empresas de Pesquisa (2002) Critério de classificacao economica do Brasil. Associacao Brasileira de Empresas de Pesquisa, Sao Paulo.

[15]   Bertoldi, A.D. (2006) Epidemiologia do acesso aos medicamentos e sua utilizacao em uma populacao assistida pelo Programa Saúde da Família. Universidade Federal de Pelotas, Pelotas.

[16]   Miranda, E.S., Pinto Cdu, B., dos Reis, A.L., et al. (2009) Availability of Generic Drugs in the Public Sector and Prices in the Private Sector in Different Regions of Brazil. Cadernos de Saúde Pública, 25, 2147-2158.
http://dx.doi.org/10.1590/S0102-311X2009001000006

[17]   Cameron, A., Ewen, M., Ross-Degnan, D., Ball, D. and Laing, R. (2009) Medicine Prices, Availability, and Affordability in 36 Developing and Middle-Income Countries: A Secondary Analysis. The Lancet, 373, 240-249.
http://dx.doi.org/10.1016/S0140-6736(08)61762-6

[18]   Jacobs, B., Ir, P., Bigdeli, M., Annear, P.L. and Van Damme, W. (2012) Addressing Access Barriers to Health Services: An Analytical Framework for Selecting Appropriate Interventions in Low-Income Asian Countries. Health Policy Plan, 27, 288-300.
http://dx.doi.org/10.1093/heapol/czr038

[19]   Helfer, A.P., Camargo, A.L., Tavares, N.U., Kanavos, P. and Bertoldi, A.D. (2012) Affordability and Availability of Drugs for Treatment of Chronic Diseases in the Public Health Care System. Revista Panamericana de Salud Pública, 31, 225-232.
http://dx.doi.org/10.1590/S1020-49892012000300007

[20]   Araujo, J.L., Pereira, M.D., de Sa Del Fiol, F. and Barberato-Filho, S. (2014) Access to Antihypertensive Agents in Brazil: Evaluation of the “Health Has No Price” Program. Clinical Therapeutics, 36, 1191-1195.
http://dx.doi.org/10.1016/j.clinthera.2014.06.003

[21]   Brasil. Ministério da Saúde (2014) National List of Essential Medicines: Rename.
http://portalsaude.saude.gov.br/images/pdf/2015/julho/30/Rename-2014-v2.pdf

[22]   Macedo, E.I., Lopes, L.C. and Barberato-Filho, S. (2011) A Technical Analysis of Medicines Request-Related Decision Making in Brazilian Courts. Revista de Saúde Pública, 45, 706-713.
http://dx.doi.org/10.1590/S0034-89102011005000044

[23]   Santos-Pinto, C.D.B., Costa, N.R. and Osorio-de-Castro, C.G.S. (2011) Quem acessa o Programa Farmácia Popular do Brasil? Aspectos do fornecimento público de medicamentos. Ciência & Saúde Coletiva, 16, 2963-2973.
http://dx.doi.org/10.1590/S1413-81232011000600034

[24]   Vieira, F.S. (2010) Pharmaceutical Assistance in the Brazilian Public Health Care System. Revista Panamericana de Salud Pública, 27, 149-156.
http://dx.doi.org/10.1590/S1020-49892010000200010

[25]   Naves Jde, O. and Silver, L.D. (2005) Evaluation of Pharmaceutical Assistance in Public Primary Care in Brasilia, Brazil. Revista de Saúde Pública, 39, 223-230.
http://dx.doi.org/10.1590/S0034-89102005000200013

[26]   Santos, V. and Nitrini, S.M. (2004) Prescription and Patient-Care Indicators in Healthcare Services. Revista de Saúde Pública, 38, 819-826.

[27]   Paniz, V.M.V., Fassa, A.G., Facchini, L.A., et al. (2008) Access to Continuous-Use Medication among Adults and the Elderly in South and Northeast Brazil. Cadernos de Saúde Pública, 24, 267-280.
http://dx.doi.org/10.1590/S0102-311X2008000200005

[28]   Pan American Health Organization (PAHO) (2010) Access to High-Cost Medicines in the Americas: Situation, Challenges and Perspectives.
http://apps.who.int/medicinedocs/documents/s19112en/s19112en.pdf

[29]   Viacava, F., Souza-Junior, P.R. and Szwarcwald, C.L. (2005) Coverage of the Brazilian Population 18 Years and Older by Private Health Plans: An Analysis of Data from the World Health Survey. Cadernos de Saúde Pública, 21, 119-128.
http://dx.doi.org/10.1590/S0102-311X2005000700013

[30]   Aurea, A.P., de Magalhaes, L.C.G., Garcia, L.P., dos Santos, C.F. and de Almeida, R.F. (2011) Programas de Assistência Farmacêutica do Governo Federal: Evolucao recente das compras diretas de medicamentos e primeiras evidências de sua eficiência, 2005-2008.
http://repositorio.ipea.gov.br/bitstream/11058/1201/1/td_1658.pdf

[31]   World Health Organization (WHO). Health Expenditure Ratios, All Countries, Selected Years Estimates by Country.
http://apps.who.int/gho/data/view.main.HEALTHEXPRATIOLATESTv

[32]   World Health Organization (WHO). Health Expenditure per Capita, All Countries, Selected Years Estimates by Country.

[33]   Relatório Mundial de Saúde. Financiamento dos Sistemas de Saúde—O caminho para a cobertura universal.
http://www.who.int/eportuguese/publications/WHR2010.pdf?ua=1

[34]   Herttua, K., Tabak, A.G., Martikainen, P., Vahtera, J. and Kivimaki, M. (2013) Adherence to Antihypertensive Therapy Prior to the First Presentation of Stroke in Hypertensive Adults: Population-Based Study. European Heart Journal, 34, 2933-2939.
http://dx.doi.org/10.1093/eurheartj/eht219

[35]   Degli Esposti, L., Saragoni, S., Benemei, S., et al. (2011) Adherence to Antihypertensive Medications and Health Outcomes among Newly Treated Hypertensive Patients. ClinicoEconomics & Outcomes Research, 3, 47-54.
http://dx.doi.org/10.2147/CEOR.S15619

[36]   Sokol, M.C., McGuigan, K.A., Verbrugge, R.R. and Epstein, R.S. (2005) Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost. Medical Care, 43, 521-530.
http://dx.doi.org/10.1097/01.mlr.0000163641.86870.af

[37]   Reisin, E., Graves, J.W., Yamal, J., et al. (2014) Controle da pressao arterial e desfechos cardiovasculares em hipertensos com peso normal, sobrepeso e obesos tratados com três anti-hipertensivos diferentes no Estudo ALLHAT. Revista Brasileira de Hipertensao, 21, 169-170.

[38]   Weber, D., de Oliveira, K.R. and Colet, C.F. (2014) Adesao ao tratamento medicamentoso e nao medicamentoso de hipertensos em Unidade Básica de Saúde. Revista Brasileira de Hipertensao, 21, 114-121.

[39]   Aziz, J.L. (2014) Sedentarismo e hipertensao arterial. Revista Brasileira de Hipertensao, 21, 75-82.

[40]   Virdis, A., Giannarelli, C., Neves, M.F., Taddei, S. and Ghiadoni, L. (2010) Cigarette Smoking and Hypertension. Current Pharmaceutical Design, 16, 2518-2525.
http://dx.doi.org/10.2174/138161210792062920

 
 
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