Inappropriate use of medicines and associated factors in Brazil: an approach from a national household survey.

Luiz Villarinho Pereira Mendes,Andrea Damaso Bertoldi,Luiz Roberto Ramos,Andréia Turmina Fontanella,Tatiane Da Silva Dal Pizzol,Vera Lucia Luiza,Mareni Rocha Farias,Noemia Urruth Leão Tavares,Mônica Rodrigues Campos,Paulo Sergio Dourado Arrais,Sotero Serrate Mengue,Maria Auxiliadora Oliveira

doi:10.1093/heapol/czz038

Abstract

This article aims to describe the inappropriate use of medicines in the Brazilian urban population and to identify associated factors. We conducted a data analysis of a household survey carried out in Brazil in 2013–14. The sampling plan was done by clusters with representativeness of the urban population and large regions of the country, according to gender and age domains. For this analysis, we considered a sample of adults (≥20 years) who reported having chronic non-communicable diseases, medical indication for drug treatment and medicine use (n = 12 283). We evaluated the prevalence of inappropriate use in the domains: non-adherence, inappropriate use behaviour and inadequate care with medicines, all verified in the following groups of independent variables: demographic and socio-economic characteristics, health and pharmaceutical care, health status and use of medicines. Crude and adjusted prevalence ratios were obtained using robust Poisson regression. It was found 46.1% of people having at least one behaviour of inappropriate use of medicines. The worst results were found for the domain of inappropriate use behaviour, a situation of 36.6% of the users, which included unauthorized prescriber, inadequate source of information and indication of the medicines by non-authorized prescribers. The best result was found for the lack of medicines care, informed by only 4.6% of users who kept expired drugs at home. The inappropriate use of medicines was associated with gender (female), region of residence (Northeast), not visiting the doctor regularly or visiting more than one doctor, not having free access to medicines and using of five or more medicines. There was a high prevalence of inappropriate use, which was associated with both individual and health system characteristics pointing out the need to set priorities as for health education and public interventions.

Highlights

The appropriate use of medicines (AUM) is inalienably linked to access to medicines as an important health system goals, both fundamental to achieve universal access to health care and coverage (Wirtz et al, 2017)
We aim to describe the inappropriate use of medicines in the Brazilian population at a household level using a synthetic indicator, identifying associated variables
Regarding the socio-economic-demographic characteristics, the weighted estimates indicated that half of the respondents self-declared themselves as white skin colour, there was a higher prevalence of women (64.8%), adults aged between 40 and 59 years (42.7%), married (61.4%), with time spent in education between 1 and 8 years (42.8%), 54.6% belonging to economic class C, 51.4% residing in the Southeast region and 71.9% having no health insurance

Summary

Introduction

The appropriate use of medicines (AUM) is inalienably linked to access to medicines as an important health system goals, both fundamental to achieve universal access to health care and coverage (Wirtz et al, 2017). The medication process involves a wide set of stakeholders from inside, as prescribers, dispensers, care keepers and patients, as well as from outside the health system, as medicines producers and vendors. The World Health Organization, as well as other broad initiatives, as ‘Medicines Transparency Alliance’ have been investing on medicines use studying methods which are suitable to be applied in low- and middle-income countries, that generally do not count on robust and well-structured information systems on this issue. It has been valuable to show problems regarding availability of medicines, storage conditions and some issues regarding appropriate use problems perceivable at the health facility level, as adherence of prescribers to standard treatment protocols and the average number of medicines per prescription (WHO, 2009). A household approach exists, enabling countries to raise relevant information (WHO, 2016)

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