Socioeconomic factors influencing access to drugs from the Specialized Component of Pharmaceutical Services in Paraná-Brazil: An observational, cross-sectional retrospective study

Limberger, Priscilla Marys; Rossignoli, Paula; Rotta, Inajara; Lazo, Raul Edison Luna; Domingues, Karime Zeraik Abdalla; Fernandez-Llimos, Fernando; Pontarolo, Roberto

doi:10.1590/s2175-97902024e23571

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Brazilian Journal of Pharmaceutical Sciences

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Article • Braz. J. Pharm. Sci. 60 • 2024 • https://doi.org/10.1590/s2175-97902024e23571 copy

Socioeconomic factors influencing access to drugs from the Specialized Component of Pharmaceutical Services in Paraná-Brazil: An observational, cross-sectional retrospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The Specialized Component of Pharmaceutical Services (CEAF) is a crucial strategy for accessing medicines through the Brazilian Public Health System, holding the highest budgetary impact on outpatient pharmaceutical care. This study aimed to assess the association of socioeconomic factors with access to CEAF drugs in municipalities throughout Paraná from 2010 to 2019. It utilized a retrospective, observational, cross-sectional approach, evaluating dispensed medication units, medication expenditure, and average unit cost. Analyses were performed to identify a correlation between the use of CEAF drugs and socioeconomic indicators. In these 10 years, the number of dispensed units practically quadrupled, and the expenditure on these drugs doubled, from BRL 214 million to BRL 476 million. The Index of Paraná Institute for Economic and Social Development of Municipal Performance (IPDM) showed a greater association with the use of CEAF drugs, and no correlation was observed between gross domestic product (GDP) per capita and the municipal population. Overall, the IPDM index that includes income, education, and health are socioeconomic factors that influence the utilization of CEAF drugs. These findings emphasize the need for health education among users and adjustment of public policies to mitigate inequalities in the CEAF drug access for the citizens of Paraná.

Keywords:
National drug policy; High-cost drugs; Pharmaceutical care; Multivariate analyses

Independent variable	Year analyzed	Database
Municipal population	2010 to 2019	IBGE
Gross Domestic Product (GDP) per capita	2010 to 2017	IBGE
Number of professionals with medical specialty	2012 to 2019	DATASUS
Index of Paraná Institute for Economic and Social Development of Municipal Performance (IPDM, acronym in Portuguese) ¹ 1 The IPDM is a synthetic index that seeks to capture the socioeconomic conditions of the municipalities of the State of Paraná in their most significant dimensions: income (composed of income, employment, and agricultural production), education, and health, following a line like that of the Human Development Index (HDI) prepared by the United Nations Development Program (UNDP).	2010 to 2016	IPARDES
IPDM- Health ² 2 IPDM – Health is composed of the variables: Percentage of more than six prenatal consultations per live births, Percentage of deaths from ill-deceased causes, Percentage of deaths of children under five years old from preventable causes per live births.	2010 to 2016	IPARDES
IPDM - Income, Employment and Agricultural Production ³ 3 IPDM – Income, Employment and Agricultural Production is composed of the variables: Average remuneration (absolute average remuneration and average remuneration growth rate), Formal employment (Index of formalization, Growth rate of Formal Employment Stock, Employment participation index formal), Agricultural Production (Participation of the Gross Value of Production - agricultural GPV of the municipality in the total and of the state, Growth rate of the agricultural GPV).	2010 to 2016	IPARDES
IPDM - Education ⁴ 4 IPDM – Education is composed of the variables: Early Childhood Education (daycare and preschool), Elementary and Secondary Education (age-grade non-distortion rate, Percentage of teachers with higher education, non-dropout rate, average education development index basic).	2010 to 2016	IPARDES

Year	Number of dispensed units	Number of medication units dispensed per inhabitant
2010	47,902,251	4.59
2011	54,576,574	5.19
2012	65,045,643	6.15
2013	73,850,783	6.72
2014	86,024,390	7.76
2015	95,366,670	8.54
2016	109,901,083	9.78
2017	127,923,793	11.30
2018	143,856,192	12.68
2019	162,181,021	14.18

Year	Financial value (BRL)	Financial value per inhabitant (BRL)
2010	214,341,868.83	20.53
2011	233,496,928.95	22.21
2012	271,539,646.77	25.67
2013	291,422,932.94	26.50
2014	328,365,386.41	29.63
2015	357,778,015.37	32.05
2016	452,131,222.28	40.22
2017	452,898,702.26	40.01
2018	436,010,702.39	38.42
2019	476,097,944.73	41.64

Year	Average cost (BRL) per medication unit dispensed
2010	4.47
2011	4.28
2012	4.17
2013	3.95
2014	3.82
2015	3.75
2016	4.11
2017	3.54
2018	3.03
2019	2.94

Independent Variable	Beta adjusted	p-value	95% CI	VIF
Score of permanence in the quartiles of the distribution of the value per dispensed unit	0.198	<0.001	-0.298; -0.119	1.111
Average population over the period	0.060	0.204	2x10^-6; 1.4x10^-5	1.288
Average GDP per capita 2010 - 2016, at current prices	0.025	0.619	-2.2 x 10^-5; 1.2x10^-4	1.503
IPDM - Health average 2010 – 2016	0.144	0.002	5.521; 25.534	1.312
IPDM - Income, Employment, and Agricultural Production average 2010 – 2016	0.128	0.024	1.952; 26.887	1.875
IPDM - Education average 2010 – 2016	0.405	<0.001	26.501; 43.0085	1.418

Variável Independente	Beta ajustado	p-valor	95% CI	VIF
Score de permanência nos quartis da distribuição do valor dispensado por habitante	0.465	<0.001	0.417; 0.582	1.111
População média durante o período	0.013	0.759	-7x10^-6; 9x10^-6	1.288
PIB per capita médio 2010 - 2016, a preços correntes	0.010	0.833	-6.3x10^-5; 7.8x10^-5	1.510
IPDM - Saúde média 2010 – 2016	0.163	<0.001	8.803; 27.115	1.312
IPDM - Renda, Emprego e Produção Agrícola média 2010 – 2016	0.109	0.032	1.074; 23.939	1.875
IPDM - Educação média 2010 – 2016	0.349	<0.001	23.046; 38.253	1.418

Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Av. Prof. Lineu Prestes, n. 580, 05508-000 S. Paulo/SP Brasil, Tel.: (55 11) 3091-3824 - São Paulo - SP - Brazil
E-mail: bjps@usp.br

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[1] *Correspondence: I. Rotta Departmento de Farmácia. Universidade Federal do Paraná. Avenida Prefeito Lothário Meissner, 632, Jardim Botânico, Curitiba, Paraná, Brasil. Phone: (41) 999225180. E-mail: inajara.rotta@ufpr.br .