ABSTRACT:

Introduction:

The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly.

Methods:

Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson’s χ², Student’s t and Anova, with a significance level of 5%.

Results:

The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries.

Conclusion:

The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.

Keywords:
Health services for the aged; Drug costs; Primary health care

INTRODUCTION

Population aging and an increase in the prevalence of chronic non-communicable diseases are challenges faced by health systems, including the Brazilian one. This change in the demographic and epidemiological profile, together with the growing incorporation of new technologies increases health costs. Thus, public policies need to be prepared to meet this new reality and ensure access to health care for the elderly, with the least possible economic impact¹1. Miranda GMD, Mendes ACG, Silva ALA. O envelhecimento populacional brasileiro: desafios e consequências sociais atuais e futuras. Rev Bras Geriatr Gerontol 2016; 19(3): 507-19. http://dx.doi.org/10.1590/1809-98232016019.150140
https://doi.org/http://dx.doi.org/10.159... ^,22. Salisbury C. Multimorbidity: redesigning health care for people who use it. Lancet 2012; 380(9836): 7-9. https://doi.org/10.1016/S0140-6736(12)60482-6
https://doi.org/https://doi.org/10.1016/... ^,33. Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM, et al. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet2011; 377(9781): 1949-61. https://doi.org/10.1016/S0140-6736(11)60135-9
https://doi.org/https://doi.org/10.1016/... .

According to the 2008-2009 Family Budget Survey (POF), medication use accounts for an significant proportion of health spending, especially for the poorest population. There are still access issues to these medicines in the public sector, often triggering the need to purchase medicines in private pharmacies, generating out-of-pocket expenses that interfere with family income⁴4. Instituto Brasileiro de Geografia e Estatística. Pesquisa de orçamentos familiares 2008-2009: despesas, rendimento e condições de vida. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010..

A large portion of the elderly Brazilian population do not have the financial resources to cover these costs. In these cases, the public service is the only form of access to drug treatment, which is guaranteed in the policies of the Unified Health System (SUS). Ensuring rational access to medicines and reducing private spending are priorities of the National Medicines Policy⁵5. Brasil. Ministério da Saúde. Portaria nº 3.916, de 30 de outubro de 1998. Dispõe sobre a aprovação da Política Nacional de Medicamentos. Diário Oficial da República Federativa do Brasil 1998; Seção 1: 18-22. and specific programs such as Pharmaceutical Assistance for Arterial Hypertension and Diabetes Mellitus⁶6. Brasil. Ministério da Saúde. Portaria nº 371/GM, de 4 de março de 2002. Institui o Programa Nacional de Assistência Farmacêutica para Hipertensão Arterial e Diabetes Mellitus. Brasília: Ministério da Saúde; 2002..

The population’s access to medicines through SUS has increased in Brazil, particularly in the state of São Paulo⁷7. Monteiro CN, Gianini RJ, Barros MBA, Cesar CLG, Goldbaum M. Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil. Rev Bras Epidemiol 2016; 19(1): 26-37. http://dx.doi.org/10.1590/1980-5497201600010003
https://doi.org/http://dx.doi.org/10.159... , however universal coverage and equity in access still face challenges⁸8. Colet CF, Borges PEM, Amador TA. Perfil de gastos com medicamentos entre idosos em diferentes grupos socioeconômicos. Rev Bras Geriatr Gerontol 2016; 19(4): 591-601. http://dx.doi.org/10.1590/1809-98232016019.150038
https://doi.org/http://dx.doi.org/10.159... . The present study aimed to analyze private spending of elderly regarding the direct purchase of medicines in a city in the state of São Paulo.

METHODOLOGY

A Population survey performed with individuals aged 60 years or older, non-institutionalized, of both sexes, living in the urban census sectors of Praia Grande, São Paulo, a municipality with approximately 260,000 inhabitants, which was classified, in 2008, by Viana et al.⁹9. Viana ALD, Rocha JSY, Elias PE, Ibañez N, Bousquat A. Atenção básica e dinâmica urbana nos grandes municípios paulistas. Brasil. Cad Saúde Pública 2008; 24 (Supl. 1): S79-90. http://dx.doi.org/10.1590/S0102-311X2008001300013
https://doi.org/http://dx.doi.org/10.159... as having low complexity in the health care network and less favorable social indicators. On the other hand, it was the first in the Baixada Santista metropolitan region to implement the Family Health Strategy (FHS), reaching 70% coverage in 2009, above the average for the state of São Paulo¹⁰10. Brasil. Ministério da Saúde. Departamento de Informática do SUS. Banco de dados do Sistema Único de Saúde (DATASUS). Brasília: Ministério da Saúde ; 2016..

In Praia Grande, as in most Brazilian municipalities, the purchase of medicines can take place in public health units or through direct purchase in private pharmacies. The Popular Pharmacy Program, created by the federal government to expand access to medicines, had little coverage in the municipality during the interview period¹1. Miranda GMD, Mendes ACG, Silva ALA. O envelhecimento populacional brasileiro: desafios e consequências sociais atuais e futuras. Rev Bras Geriatr Gerontol 2016; 19(3): 507-19. http://dx.doi.org/10.1590/1809-98232016019.150140
https://doi.org/http://dx.doi.org/10.159... .

This work consists of a thematic section of a research project entitled Public Private Mix in the Use of Primary Care Services, which began from the hypothesis of the existence of an important link between the public and the private sector regarding the use of health services in Brazil.

A probabilistic sampling by clusters was performed in two stages, considering the census sectors as the primary unit. In the first stage, 40 census tracts were drawn with probability proportional to the size of residents, based on the 2010 population census. In each sector, by listing all existing households, 40 households were selected by systematic drawing, with a total of 1,600. For a sampling error of 10 percentage points, a design effect of 2 and a 95% confidence interval level, the minimum sample size was calculated at 200 elderly.

The face-to-face home interviews took place from October 2012 to April 2013, using structured questionnaires, applied by previously trained interviewers who always worked in pairs. All elderly people living at home were interviewed regarding their demographic characteristics, health conditions and use of health services. The Brazilian Economic Classification Criterion (CCEB)¹²12. Associação Brasileira de Empresas de Pesquisa (São Paulo). Critério de Classificação Econômica Brasil. Dados com Base no Levantamento Sócio Econômico: 2011. São Paulo: Associação Brasileira de Empresas de Pesquisa; 2012. was used to assess the socioeconomic conditions of the families.

The questions regarding the use of medications were applied to everyone who used medications in the 15 day period prior to the interview. The elderly were questioned about: responsible person for the indication or prescription, names of medicines, dosage, continuous use or not, place of purchase and amount paid in Reais, when purchased at a private pharmacy. The interview participants were asked for the package, prescription or package insert for the pharmaceutical products used to minimize the rates of non-responses due to general forgetfulness.

The individual monthly amount spent was calculated by adding all the amounts spent by the elderly on the purchase of medicines in private pharmacies (out-of-pocket) for one month of treatment and informed during the interview. When the amount spent was not informed by the elderly, this value was estimated by means of the simple average between the maximum consumer prices allowed by the legislation for each pharmaceutical laboratory, including the Tax on Circulation of Goods and Services (ICMS) with the rate of 18 %, applied in the state of São Paulo¹³13. Brasil. Ministério da Saúde. Câmara de Regulação do Mercado de Medicamentos. Listas de preços de medicamentos [Internet]. Brasília: Agência Nacional de Vigilância Sanitária; 2012 [acessado em 1º jun. 2016]. 640 p. Disponível em: Disponível em: http://portal.anvisa.gov.br/documents/374947/410050/LISTA%2BCONFORMIDADE_2012-10-23.pdf/90114996-07c2-42b9-9e46-4d1354236473
http://portal.anvisa.gov.br/documents/37... . The simple average avoided possible distortions caused by discrepant prices, practiced by some pharmaceutical laboratories.

For the purpose of calculating the amount spent, when the dosage of any medication was not informed, the standard dosage was considered in its main indication, using the National Therapeutic Form as a reference¹⁴14. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Formulário Terapêutico Nacional 2010. Rename 2010. Brasília: Ministério da Saúde ; 2010. 1140 p..

The average amount spent in private pharmacies was calculated by calculating the mean between the monthly average per capita values. Income impairment with the purchase of medicines was obtained by dividing the average amount spent by the family income per capita and the quotient multiplied by 100, in order to express the total as a percentage. The ratio between the variables was calculated based on the quotient between the average of values spent.

All categorical variables were described in absolute and relative frequencies and numerical variables using means and standard deviations. The following hypothesis tests used were: Pearson’s χ2 for categorical variables and Student’s t test, for two independent groups; and analysis of variance (Anova), for more than two independent groups in order to compare the means. The Shapiro-Wilk normality test was used for the distribution of numerical variables. The level of significance adopted in all analyzes was 5%. The analyzes were performed by the survey module of the Stata 10.0 statistical package for complex samples.

The drugs used were classified according to the anatomical group as level 1 according to the Anatomical Therapeutic Chemical Classification System (ATC)¹⁵15. World Health Organization (WHO). WHO Collaborating Centre for Drug Statistics Methodology [Internet]. ATC/DDD Index 2016. World Health Organization; 2016 [acessado em fev. 2016]. Disponível em: Disponível em: http://www.whocc.no/atcddd/
http://www.whocc.no/atcddd/... , as:

The other groups were combined and given other names.

The study was approved by the Research Ethics Committee of the Catholic University of Santos (opinion 01341012400005536, of June 18, 2012).

RESULTS

289 elderly people participated in the study, a sample greater than the calculated minimum (n = 200), with a mean age of 69.4 and a median of 68 years. The prevalence of medication use in the 15 days prior to the interview was 61.2% (n = 177). The number of medications used varied between one and 11, with an average of 2.9 medications per person. According to the interviewees, 69.5% of the drugs were prescribed by SUS health professionals, and 75.7% of the elderly obtained at least one of the medicines provided by SUS.

Table 1 shows that the majority were women, with socioeconomic classification C, low education, with SUS being the first alternative in health care, without private health insurance, with chronic pathology and who attended a health service in the last year. Regarding the perception of health, it was evenly distributed between good and fair/bad.

The average per capita expenditure on medicines was R$34.59. Spending and income impairment were higher for elderly with more than eight years of study, without chronic diseases, beneficiaries of health insurance plans, affiliated with the private sector (Table 2).

The drugs were grouped in anatomical systems, at the first level of the ATC classification, and the percentages of use, acquisition at SUS and expenditure on direct purchase at private pharmacies at each level studied were presented (Table 3). Medicines that treat cardiovascular system diseases exhibited the highest frequency of use, followed by those for the gastrointestinal tract and metabolism, blood and hematopoietic organs and nervous system. The purchase of medicines for these four anatomical systems occurred predominantly through SUS. All medications that did not fit into any of these systems were classified as other.

The drugs classified as cardiovascular system were the most used (46.0%), in particular the pharmacological angiotensin-converting enzyme inhibitor subgroups (35.7%) and low-ceiling thiazide diuretics (21.9%). Private spending per capita for this class was R$34.16.

Medicines for the gastrointestinal tract and metabolism were also widely used by the elderly, 80% of whom were oral hypoglycemic agents. In this group, the average expenditure per capita was R$30.19. Medicines for blood and hematopoietic organs and the nervous system were also widely used, with average per capita spending of R$12.31 and R$26.23, respectively.

DISCUSSION

The sociodemographic profile observed among the elderly interviewed is consistent with official data of the municipality¹⁶16. Brasil. Ministério da Saúde. Coordenação de Saúde da Pessoa Idosa. Sistema de Indicadores de Saúde e Acompanhamento de Políticas do Idoso (SISAP). Brasília: Ministério da Saúde ; 2010., with a predominance of low-educated and low- income population with SUS as the first reference for health care.

The number of elderly people found was higher than expected in the sample calculation. This fact can be explained in two non-exclusive ways: accelerated migration of retirees to Baixada Santista and greater willingness of the elderly to participate in the interviews.

The percentage of elderly people who reported having attended a health service in the last 12 months was lower than the findings of the National Household Sample Survey (PNAD 1998 and 2003)¹⁷17. Lima-Costa MF, Loyola Filho AI, Matos DL. Tendências nas condições de saúde e uso de serviços de saúde entre idosos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998, 2003). Cad Saúde Pública 2007; 23(10): 2467-78. http://dx.doi.org/10.1590/S0102-311X2007001000021
https://doi.org/http://dx.doi.org/10.159... and the National Health Survey 2013¹⁸18. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde 2013. Rio de Janeiro: IBGE; 2013., which is an important indicator used to assess health services access of a specific population. Regarding Praia Grande, with wide FHS coverage, this result is contrary to expectations¹⁹19. Pinto LF, Giovanella L. Do Programa à Estratégia Saúde da Família: expansão do acesso e redução das internações por condições sensíveis à atenção básica (ICSAB). Ciênc Saúde Coletiva 2018; 23(6): 1903-14. http://dx.doi.org/10.1590/1413-81232018236.05592018
https://doi.org/http://dx.doi.org/10.159... .

Another indicator commonly used to assess health access is usually the use of medicines, which, in our study, was lower than the results obtained by other studies²⁰20. Flores VB, Benvegnu LA. Use of medicines by the elderly in Santa Rosa, Rio Grande do Sul State, Brazil. Cad Saúde Pública 2008; 24(6): 1439-46. http://dx.doi.org/10.1590/S0102-311X2008000600024
https://doi.org/http://dx.doi.org/10.159... ^,2121. Loyola Filho AI, Uchoa E, Lima-Costa MF. A population-based study on use of medication by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil. Cad Saúde Pública 2006; 22(12): 2657-67. http://dx.doi.org/10.1590/S0102-311X2006001200015
https://doi.org/http://dx.doi.org/10.159... ^,2222. Marin MJS, Cecílio LCO, Perez AEWUF, Santella F, Silva CBA, Gonçalves-Filho JR, et al. Caracterização do uso de medicamentos entre idosos de uma unidade do Programa Saúde da Família. Cad Saúde Pública 2008; 24(7): 1545-55. http://dx.doi.org/10.1590/S0102-311X2008000700009
https://doi.org/http://dx.doi.org/10.159... ^,2323. Neves SJF, Marques APO, Leal MCC, Diniz AS, Medeiros TS, Arruda IKG. Epidemiology of medication use among the elderly in an urban area of Northeastern Brazil. Rev Saúde Pública 2013; 47(4): 759-68. http://dx.doi.org/10.1590/S0034-8910.2013047003768
https://doi.org/http://dx.doi.org/10.159... ^,2424. Muniz ECS, Goulart FC, Lazarini CA, Marin MJS. Analysis of medication use by elderly persons with supplemental health insurance plans. Rev Bras Geriatr Gerontol 2017; 20(3): 374-86. http://dx.doi.org/10.1590/1981-22562017020.160111
https://doi.org/http://dx.doi.org/10.159... ^,2525. Ribeiro AQ, Rozenfeld S, Klein CH, César CC, Acurcio FA. Inquérito sobre uso de medicamentos por idosos aposentados. Belo Horizonte, MG. Rev Saúde Pública 2008; 42(4): 724-32. http://dx.doi.org/10.1590/S0034-89102008005000031
https://doi.org/http://dx.doi.org/10.159... . Different variables can interfere with medication adherence, including the economic cost of treatment²⁶26. Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication nonadherence: a review of the literature. J Gen Intern Med 2007; 22(6): 864-71. https://doi.org/10.1007/s11606-007-0180-x
https://doi.org/https://doi.org/10.1007/... ^,2727. Loyola Filho AI, Firmo JOA, Mambrini JVM, Peixoto SV, Souza-Junior PRB, Bof De Andrade F, et al. Costrelated underuse of medications in older adults: ELSI-Brazil. Rev Saúde Pública 2018; 52 (Supl. 2): 8s. http://dx.doi.org/10.11606/s1518-8787.2018052000622
https://doi.org/http://dx.doi.org/10.116... . As the income impairment was the main focus, the discussion happened in this context. In addition, it was not asked during the interviews whether the elderly had stopped using any prescription medication and what were the reasons that led them to do so, this being a limitation of the work and to delve into the issue of underutilization.

With a prevalence of chronic diseases in the municipality similar to the national one for the same age group²⁸28. Passos VMA, Assis TD, Barreto SM. Hipertensão arterial no Brasil: estimativa de prevalência a partir de estudos de base populacional. Epidemiol Serv Saúde 2006; 15(1): 35-45. http://dx.doi.org/10.5123/S1679-49742006000100003
https://doi.org/http://dx.doi.org/10.512... and self-perceived regular or poor health of 35.4%, the economic cost may have contributed to the low use of medicines, as observed in other studies²⁹29. Heisler M, Langa KM, Eby EL, Fendrick AM, Kabeto MU, Piette JD. The health effects of restricting prescription medication use because of cost. Med Care 2004; 42(7): 626-34. https://doi.org/10.1097/01.mlr.0000129352.36733.cc
https://doi.org/https://doi.org/10.1097/... ^,3030. Lima-Costa MF, Barreto SM, Giatti L. Condições de saúde, capacidade funcional, uso de serviços de saúde e gastos com medicamentos da população idosa brasileira: um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios. Cad Saúde Pública 2003; 19(3): 735-43. http://dx.doi.org/10.1590/S0102-311X2003000300006
https://doi.org/http://dx.doi.org/10.159... ^,3131. Safran DG, Neuman P, Schoen C, Kitchman MS, Wilson IB, Cooper B, et al. Prescription drug coverage and seniors: findings from a 2003 national survey. Health Aff 2005; 24: 152-67. https://doi.org/10.1377/hlthaff.w5.152
https://doi.org/https://doi.org/10.1377/... ^,3232. Luz TCB, Loyola Filho AI, Lima-Costa MF. Estudo de base populacional da subutilização de medicamentos por motivos financeiros entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil. Cad Saúde Pública 2009; 25(7): 1578-86. http://dx.doi.org/10.1590/S0102-311X2009000700016
https://doi.org/http://dx.doi.org/10.159... . In addition, 41.2% of elderly people living in Praia Grande have an income of up to one minimum wage and 10% live in poverty³³33. Brasil. Ministério da Saúde. Sistema de Indicadores de Saúde e Acompanhamento de Políticas do Idoso [Internet]. Brasília: Ministério da Saúde ; 2010 [acessado em jun. 2014]. Disponível em: Disponível em: http://www.saudeidoso.icict.fiocruz.br/
http://www.saudeidoso.icict.fiocruz.br/... .

The average per capita expenditure on medicines was R$34.59, referring to 5.6% of the minimum wage in force at the time (R$622), a percentage lower than that verified in a population-based study in Brazil³⁰30. Lima-Costa MF, Barreto SM, Giatti L. Condições de saúde, capacidade funcional, uso de serviços de saúde e gastos com medicamentos da população idosa brasileira: um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios. Cad Saúde Pública 2003; 19(3): 735-43. http://dx.doi.org/10.1590/S0102-311X2003000300006
https://doi.org/http://dx.doi.org/10.159... . The low prevalence of medication use associated with the reduced average per capita expenditure on medicines in the municipality suggests the underuse of medicines.

The average per capita expenditure on the purchase of medication is higher among elderly men and those with higher education corroborating with the information from the PNAD³⁰30. Lima-Costa MF, Barreto SM, Giatti L. Condições de saúde, capacidade funcional, uso de serviços de saúde e gastos com medicamentos da população idosa brasileira: um estudo descritivo baseado na Pesquisa Nacional por Amostra de Domicílios. Cad Saúde Pública 2003; 19(3): 735-43. http://dx.doi.org/10.1590/S0102-311X2003000300006
https://doi.org/http://dx.doi.org/10.159... and the National Health Survey³⁴34. Mengue SS, Tavares NUL, Costa KS, Malta DC, Silva Júnior JB. Fontes de obtenção de medicamentos para tratamento de hipertensão arterial no Brasil: análise da Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol 2015; 18(Supl. 2): 192-203. http://dx.doi.org/10.1590/1980-5497201500060017
https://doi.org/http://dx.doi.org/10.159... . Those with less education, on the other hand, received their medication from SUS. Ensuring access to medicines in the public sector is essential, especially for the low-income population, as in some cases these expenses can negatively affect the family budget. A population-based study carried out in a period similar to this study showed that catastrophic spending on the purchase of medicines was present in 3.2% of Brazilian households³⁵35. Luiza VL, Tavares NUL, Oliveira MA, Arrais PSD, Ramos LR, Pizzol TSD, et al. Catastrophic expenditure on medicines in Brazil. Rev Saúde Pública 2016; 50(Supl. 2): 15s. http://dx.doi.org/10.1590/s1518-8787.2016050006172
https://doi.org/http://dx.doi.org/10.159... . The design of a universal health care system depends on organizational and financial arrangements in order to minimize out-of-pocket expenses.

The result found of greater income impairment with the purchase of medicines for the beneficiaries of health plans and who have the private sector as a reference is similar to that verified in a study carried out in the municipality of Sorocaba, in the state of São Paulo³⁶36. Duarte LR, Gianini RJ, Ferreira LR, Camargo MAS, Galhardo SD. Hábitos de consumo de medicamentos entre idosos usuários do SUS e de plano de saúde. Cad Saúde Coletiva 2012; 20(1): 64-71.. Due to the socioeconomic profile found in Praia Grande (predominantly class C), it would be important to establish measures to guarantee access to medicines, including the elderly in the private sector.

Respondents with chronic diseases had less income impairment with the purchase of medicines. Public policies guarantee access to drug therapy for the treatment of chronic diseases, especially hypertension and diabetes mellitus and reduce private spending³⁷37. Luiza VL, Chaves LA, Silva RM, Emmerick ICM, Chaves GC, Fonseca de Araújo SC, et al. Pharmaceutical policies: effects of cap and co-payment on rational use of medicines. Cochrane Database Syst Rev 2015; (5). https://doi.org/10.1002/14651858.CD007017.pub2
https://doi.org/https://doi.org/10.1002/... ^,3838. Tavares NUL, Bertoldi AD, Mengue SS, Arrais PSD, Luiza VL, Oliveira MA, et al. Factors associated with low adherence to medicine treatment for chronic diseases in Brazil. Rev Saúde Pública 2016; 50(Supl. 2): 10s. http://dx.doi.org/10.1590/s1518-8787.2016050006150
https://doi.org/http://dx.doi.org/10.159... ^,3939. Paniz VMV, Fassa ACG, Facchini LA, Piccini RX, Tomasi E, Thumé E, et al. Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed. Cad Saúde Pública 2010; 26(6): 1163-74. http://dx.doi.org/10.1590/S0102-311X2010000600010
https://doi.org/http://dx.doi.org/10.159... . A cross-sectional study carried out in two regions of the country found that the FHS had a greater impact on access to medicines for these two pathologies³⁹39. Paniz VMV, Fassa ACG, Facchini LA, Piccini RX, Tomasi E, Thumé E, et al. Free access to hypertension and diabetes medicines among the elderly: a reality yet to be constructed. Cad Saúde Pública 2010; 26(6): 1163-74. http://dx.doi.org/10.1590/S0102-311X2010000600010
https://doi.org/http://dx.doi.org/10.159... , a result similar to that found here.

The profile of medication use was similar to that described in the literature for the same age group²⁰20. Flores VB, Benvegnu LA. Use of medicines by the elderly in Santa Rosa, Rio Grande do Sul State, Brazil. Cad Saúde Pública 2008; 24(6): 1439-46. http://dx.doi.org/10.1590/S0102-311X2008000600024
https://doi.org/http://dx.doi.org/10.159... ^,2121. Loyola Filho AI, Uchoa E, Lima-Costa MF. A population-based study on use of medication by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil. Cad Saúde Pública 2006; 22(12): 2657-67. http://dx.doi.org/10.1590/S0102-311X2006001200015
https://doi.org/http://dx.doi.org/10.159... ^,2222. Marin MJS, Cecílio LCO, Perez AEWUF, Santella F, Silva CBA, Gonçalves-Filho JR, et al. Caracterização do uso de medicamentos entre idosos de uma unidade do Programa Saúde da Família. Cad Saúde Pública 2008; 24(7): 1545-55. http://dx.doi.org/10.1590/S0102-311X2008000700009
https://doi.org/http://dx.doi.org/10.159... , with greater medication consumption for treatment and control of the main chronic pathologies that affect the elderly, such as arterial hypertension and diabetes.

CONCLUSION

The prevalence of medication use was low. The cost generated by the purchase of medicines is one of the ways in which societal equality manifests. The expansion of the free supply of medicines would be necessary to expand access and avoid spending, especially for those who have private health plans, but who are unable to afford drug treatment. Further studies on the possible underutilization of drugs would be important to make a more accurate diagnosis of municipal pharmaceutical assistance.

ACKNOWLEDGEMENTS

We would like to thank Paulo Angelo Lorandi for his contribution in revising the manuscript.

References

Publication Dates

History