Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study

Bertoldi, Andrea Dâmaso; Silveira, Marysabel Pinto Telis; Machado, Adriana Kramer Fiala; Xavier, Mariana Otero; Martins, Rafaela Costa

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Brasil

Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (1) • Jan-Dec 2021 • https://doi.org/10.1590/S1679-49742021000100005 copy

Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study^* * This study received financial support from the Academic Excellence Program of the Coordination for the Improvement of Higher Education Personnel (Capes) (Funding Code 001; Process No. 23038.002445/2015-97), and National Council for Scientific and Technological Development (CNPq).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil.

Methods

This was a cross-sectional study conducted in 2016 with adults ≥18 years old. Participants reported on medication use and sources of access to medication in the month prior to the interview. Poisson regression was used.

Results

Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some form of medication and 3.3% (95%CI 2.4;4.5) stopped taking necessary medication. Higher prevalence of use occurred in: women (PR=1.23 - 95%CI 1.12;1.34), the elderly (PR=2.36 - 95%CI 2.05;2.73), people with poorer self-perceived health (PR=1.29 - 95%CI 1.14;1.46) and people with a higher number of diseases (PR=2.37 - 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medication exclusively from the Brazilian National Health System, prevalence of which was higher among those who self-reported themselves to be non-white and from lower economic classification.

Conclusion

A low number stopped taking medication they needed to take. Use of free-of-charge medication was greater in groups with lower income.

Keywords:
Health Surveys; Rural Areas; Rural Health; Pharmacoepidemiology; Pharmaceutical Services; Drug Utilization

Variables	Total		Medication use
Variables	n	%	n	% (95%CI^a)
Sex
Male	734	48.3	349	47.2 (40.8;53.7)
Female	785	51.7	485	61.6 (54.9;67.8)
Age (years)
18-39	515	34.0	166	32.0 (27.1;37.3)
40-59	593	39.2	332	55.7 (50.9;60.4)
≥60	411	26.8	336	81.9 (71.1;89.2)
Self-reported skin color
White	1.296	85.1	714	54.9 (48.9;60.7)
Non-white	223	14.9	120	53.4 (41.4;65.0)
Lives with partner
No	443	29.2	228	51.0 (44.6;57.3)
Yes	1.076	70.8	606	56.2 (49.4;62.7)
Schooling
No schooling/incomplete elementary education	996	66.1	609	60.7 (52.2;68.7)
Complete elementary education/incomplete high school education	233	15.4	92	39.2 (31.0;48.1)
Complete high school education/incomplete higher education	213	14.0	89	41.9 (36.0;48.1)
Complete higher education or above	67	4.5	36	53.4 (42.4;64.0)
Economic classification
A/B	301	20.0	170	56.5 (49.9;62.9)
C	814	53.7	436	53.4 (46.2;60.4)
D/E	388	26.3	221	56.3 (47.5;64.8)
Current work situation
Not working	613	40.5	420	68.3 (62.0;74.0)
Working	906	59.5	414	45.3 (39.3;51.6)
Self-perceived health
Very good/good	964	64.1	404	41.6 (36.0;47.5)
Regular	461	30.4	349	75.6 (64.2;84.3)
Poor/very poor	82	5.5	72	87.7 (78.7;93.2)
Number of chronic diseases
None	631	41.8	162	25.6 (21.0;30.8)
1 - 2	614	40.2	426	69.2 (63.0;74.7)
3 or more	274	18.0	246	89.6 (72.5;96.6)
Registered with Family Health Strategy
No	423	28.6	212	49.9 (37.5;62.3)
Yes	1.070	71.4	608	56.6 (52.2;60.9)
Distance from home to pharmacy
Easy to access	941	62.8	497	52.4 (46.2;58.6)
Hard to access	563	37.2	325	57.8 (50.0;65.1)
Distance from home to nearest primary healthcare center
Far, but easy to access	179	11.7	94	51.8 (42.7;60.8)
Far and hard to access	121	7.9	66	54.8 (45.4;63.8)
Close and easy to access	1.107	74.3	606	54.5 (48.3;60.5)
Close, but hard to access	92	6.1	56	61.0 (47.4;73.2)
Total	1,519	100.0	834	54.7 (48.7;60.5)

Variables	Medication use
	Crude analysis		Adjusted analysis
	PR^a (95%CI^b)	p-value^c	PRa (95%CI^b)	p-value^c
Sex		<0.001		<0.001
Male	1.00		1.00
Female	1.30 (1.18;1.45)		1.23 (1.12;1.34)
Age (years)		<0.001^d		<0.001d
18-39	1.00		1.00
40-59	1.74 (1.54;1.97)		1.74 (1.54;1.97)
≥60	2.56 (2.23;2.84)		2.36 (2.05;2.73)
Self-reported skin color		0.800		0.483
White	1.00		1.00
Non-white	0.97 (0.79;1.20)		1.07 (0.89;1.28)
Schooling		<0.001^d		0.623
No schooling/incomplete elementary	1.00		1.00
Complete elementary/incomplete high school	0.65 (0.51;0.82)		0.92 (0.73;1.17)
Complete high school/incomplete higher education	0.69 (0.60;0.80)		0.92 (0.80;1.07)
Complete higher education or above	0.88 (0.70;1.11)		0.98 (0.75;1.27)
Lives with partner		0.079		0.016
No	0.91 (0.81;1.01)		0.88 (0.80;0.98)
Yes	1.00		1.00
Economic classification		0.586		0.667
A/B	1.00		1.00
C	0.94 (0.80;1.12)		0.94 (0.80;1.11)
D/E	1.00 (0.83;1.20)		0.93 (0.80;1.09)
Current work situation		<0.001		0.005
Not working	1.00		1.00
Working	0.66 (0.59;0.75)		0.82 (0.71;0.94)
Self-perceived health		<0.001d		<0.001
Very good/good	1.00		1.00
Regular	1.82 (1.62;2.04)		1.29 (1.17;1.42)
Poor/very poor	2.11 (1.85;2.39)		1.29 (1.14;1.46)
Number of chronic diseases		<0.001^d		<0.001^d
None	1.00		1.00
1 - 2	2.71 (2.31;3.16)		2.23 (1.92;2.58)
3 or more	3.50 (2.98;4.12)		2.37 (2.03;2.77)
Registered with Family Health Strategy		0.292		0.270
No	1.00		1.00
Yes	1.13 (0.89;1.44)		1.15 (0.89;1.47)
Distance from home to pharmacy		0.120		0.222
Easy to access	1.00		1.00
Hard to access	1.10 (0.97;1.25)		1.06 (0.96;1.17)
Distance from home to nearest primary healthcare center	0.384		0.459	0,459
Far, but easy to access	1.00		1.00
Far and hard to access	1.06 (0.86;1.30)		0.98 (0.83;1.15)
Close and easy to access	1.05 (0.90;1.22)		1.08 (0.95;1.23)
Close, but hard to access	1.18 (0.98;1.42)		1.02 (0.86;1.21)

Variables	Sources of access to medication
	SUS^b	Private establishment	Mixed (SUS and private establishment)
	(n=116)	(n=380)	(n=333)
	%(IC95%^c)	%(IC95%^c)	%(IC95%^c)
Sex
Male	17.3 (13.1;22.5)	49.3 (43.0;55.7)	33.3 (27.4;39.9)
Female	11.6 (8.5; 15.8)	43.3 (36.7; 50.2)	45.0 (40.0; 50.2)
Age (years)
18-39	17.4 (12.0;24.6)	57.9 (48.0;67.2)	24.7 (18.3;32.4)
40-59	14.5 (11.4;18.2)	43.7 (38.0;49.6)	41.8 (36.1;47.8)
≥60	11.9 (8.4;16.5)	41.9 (34.4;49.9)	46.2 (38.5;54.1)
Self-reported skin color
White	12.5 (9.8;15.8)	47.8 (42.2;53.5)	39.7 (34.5;45.0)
Non-white	22.9 (16.4;31.1)	33.9 (24.5;44.9)	43.2 (35.4;51.3)
Lives with partner
No	15.5 (10.9;21.7)	40.3 (35.1;45.8)	44.1 (39.3;49.1)
Yes	13.4 (10.6;16.9)	47.9 (41.6;54.2)	38.7 (33.2;44.4)
Schooling
No schooling/incomplete elementary	14.0 (10.9;17.9)	41.3 (35.1;47.7)	44.8 (38.8;50.9)
Complete elementary/incomplete high school	12.1 (5.8;23.3)	54.8 (40.5;68.4)	33.1 (21.8;46.8)
Complete high school /incomplete higher education	18.0 (10.2;29.9)	53.3 (42.4;64.0)	28.6 (18.6;41.4)
Complete higher education or above	9.2 (3.0;24.9)	79.1 (64.2;88.8)	11.7 (5.4;23.5)
Economic classification
A/B	9.9 (6.0;15.9)	60.3 (53.3;67.0)	29.8 (22.3;38.7)
C	12.3 (9.1;16.5)	43.3 (36.0;50.9)	44.3 (37.6;51.3)
D/E	20.8 (15.3;27.7)	37.9 (30.8;45.7)	41.3 (35.6;47.1)
Current work situation
Not working	12.4 (8.9;17.1)	36.5 (30.9;42.5)	51.1 (45.4;56.9)
Working	15.7 (12.3;19.7)	55.5 (49.5;61.3)	28.9 (23.4;35.1)
Self-perceived health
Very good/good	17.2 (14.1;20.9)	50.3 (44.4;56.2)	32.5 (27.2;38.3)
Regular	10.1 (6.7;14.9)	42.9 (36.1;50.0)	47.0 (39.9;54.1)
Poor/very poor	13.2 (5.7;27.8)	35.0 (21.0;52.3)	51.8 (39.2;64.1)
Number of chronic diseases
None	16.2 (10.6;24.1)	69.6 (59.0;78.5)	14.2 (8.3;23.1)
1 - 2	15.3 (12.0;19.2)	45.2 (39.2;51.4)	39.5 (33.7;45.7)
3 or more	10.3 (6.5;16.0)	31.1 (23.7;39.6)	58.6 (50.7;66.2)
Registered with Family Health Strategy
No	12.1 (7.8;18.3)	54.0 (46.5;61.4)	33.9 (30.1;37.9)
Yes	14.7 (11.6;18.4)	42.6 (36.6;48.9)	42.7 (36.6;49.0)
Distance from home to pharmacy
Easy to access	15.0 (11.5;19.4)	45.4 (38.8;52.0)	39.6 (33.6;46.0)
Hard to access	12.7 (9.4;16.9)	46.4 (40.6;52.3)	40.9 (35.7;46.4)
Distance from home to nearest Primary Healthcare Center
Far, but easy to access	10.7 (5.5;19.7)	49.7 (37.5;61.9)	39.6 (29.2;51.1)
Far and hard to access	12.4 (6.5;22.6)	52.7 (39.8;65.3)	34.9 (25.1;46.1)
Close and easy to access	15.0 (11.9;18.8)	43.7 (38.6;49.0)	41.2 (35.8;46.9)
Close, but hard to access	13.1 (7.3;22.3)	49.9 (32.2;67.7)	37.0 (23.4;53.1)
Total	14.0 (11.2;17.4)	45.8 (40.3;51.4)	40.2 (35.5;45.0)

Variables	Adjusted analysis
Variables	PR^a (IC95%^b)	p-value^c	PR^a (IC95%^b)	p-value^c
Sex		0.040		0.055
Male	1.00		1.00
Female	0.67 (0.46;0.98)		0.68 (0.46;1.01)
Age (years)		0.178		0.441
18-39	1.00		1.00
40-59	0.83 (0.54;1.28)		0.84 (0.54;1.30)
≥60	0.68 (0.45;1.05)		0.72 (0.43;1.20)
Self-reported skin color		0.004		0.004
White	1.00		1.00
Non-white	1.83 (1.24;2.71)		1.82 (1.24;2.66)
Schooling		0.612		0.197
No schooling/incomplete elementary	1.00		1.00
Complete elementary/incomplete high school	0.86 (0.41;1.81)		0.82 (0.39;1.74)
Complete high school /incomplete higher education	1.29 (0.70;2.39)		1.65 (0.91;2.97)
Complete higher education or above	0.66 (0.23;1.88)		1.09 (0.33;3.64)
Lives with partner		0.405		0.777
No	1.15 (0.81;1.64)		1.05 (0.73;1.52)
Yes	1.00		1.00
Economic classification		0.010e		0.004e
A/B	1.00		1.00
C	1.25 (0.71;2.19)		1.34 (0.76;2.37)
D/E	2.11 (1.21;3.70)		2.48 (1.30;4.76)
Current work situation		0.176		0.192
Not working	1.00		1.00
Working	1.26 (0.89;1.78)		1.30 (0.87;1.94)
Self-perceived health		0.053		0.013
Very good/good	1.00		1.00
Regular	0.59 (0.38;0.91)		0.53 (0.35;0.80)
Poor/very poor	0.77 (0.38;1.56)		0.69 (0.33;1.44)
Number of chronic diseases		0.153		0.254
None	1.00		1.00
1 - 2	0.94 (0.58;1.53)		0.99 (0.67;1.47)
3 or more	0.63 (0.37;1.10)		0.68 (0.39;1.20)
Registered with Family Health Strategy		0.391		0.368
No	1.00		1.00
Yes	1.21 (0.77;1.92)		1.21 (0.79;1.84)
Distance from home to pharmacy		0.318		0.312
Easy to access	1.00		1.00
Hard to access	0.84 (0.60;1.19)		0.83 (0.57;1.20)
Distance from home to nearest primary healthcare center	0.777		0.952	0,952
Far, but easy to access	1.00		1.00
Far and hard to access	1.16 (0.54;2.50)		1.08 (0.53;2.20)
Close and easy to access	1.41 (0.70;2.84)		1.14 (0.61;2.13)
Close, but hard to access	1.22 (0.55;2.72)		0.96 (0.46;1.99)

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[1] Correspondence:Rafaela Costa Martins - Rua Marechal Deodoro, No. 1160, 3º piso, Centro, Pelotas, RS, Brazil. Postcode: 96020-220. E-mail: rafamartins1@gmail.com