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Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal

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Abstract

Background In view of the current financial and demographic situation in Portugal, accessibility to health care may be affected, including the ability to adhere to medication. Objective To evaluate the perceived effects of the crisis on elderly patient’s access to medicines and medical care, and its implications on medicine-taking behaviour. Setting Community pharmacy. Method A cross-sectional study was undertaken during April 2013, where elderly patients answered a self-administered questionnaire based on their health-related experiences in the current and previous year. Binary logistic regression was used to ascertain the effects of potential predictors on the likelihood of adherence. Main outcome measures self-reported adherence. Results A total of 1231 questionnaires were collected. 27.3% of patients had stopped using treatments or health services in the previous year for financial motives; mostly private medical appointments, followed by dentist appointments. Almost 30% of patients stopped purchasing prescribed medicines. Over 20% of patients reduced their use of public services. Out-of-pocket expenses with medicines were considered higher in the current year by 40.1% of patients. The most common strategy developed to cope with increasing costs of medicines was generic substitution, but around 15% of patients also stopped taking their medication or started saving by increasing the interdose interval. Conclusion Reports of decreasing costs with medicines was associated with a decreased likelihood of adherence (OR 0.42; 95% CI 0.27–0.65). Lower perceived health status and having 3 or more co-morbidities were associated with lower odds of adhering, whilst less frequent medical appointments was associated with a higher likelihood of exhibiting adherence.

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References

  1. Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, et al. Financial crisis, austerity, and health in Europe. Lancet. 2013;381:1323–31.

    Article  PubMed  Google Scholar 

  2. Sakellarides C, Castelo-Branco L, Barbosa P, Azevedo H. The impact of the financial crisis on the health system and health in Portugal. European Observatory on Health Systems and Policies. Copenhagen: WHO Regional Office for Europe 2014.

  3. Leopold C, Mantel-Teeuwisse AK, Vogler S, Valkova S, de Joncheere K, Leufkens HGM, et al. Effect of the economic recession on pharmaceutical policy and medicine sales in eight European countries. Bull World Health Organ. 2014;92:630–40.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009;374:315–23.

    Article  PubMed  Google Scholar 

  5. Quaglio G, Karapiperis T, Van Woensel L, Arnolda E, McDaid D. Austerity and health in Europe. Health Policy. 2013;113:13–9.

    Article  PubMed  Google Scholar 

  6. Graça L, Loureiro MI. A(s) crise(s) e a(s) resposta(s) da saúde pública. Crisis (s) and answer (s) of public health. Rev Port Saúde Pública. 2012;30(2):103–4.

    Article  Google Scholar 

  7. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet. 2011;378(22):1457–8.

    Article  PubMed  Google Scholar 

  8. Piette JD, Mendoza-Avelares MO, Chess L, Milton EC, Matiz Reyes A, Rodriguez-Saldaña J. Report on Honduras: ripples in the pond—the financial crisis and remittances to chronically ill patients in Honduras. J Int Health Serv. 2012;42:197–212.

    Article  Google Scholar 

  9. Quintal C, Lourenço O, Ferreira P. Utilização de cuidados de saúde pela população idosa portuguesa: uma análise por género e classes latentes. Health care utilization of the elderly Portuguese population: an analysis by gender and latent classes. Rev Port Saúde Pública. 2012;30(1):35–46.

    Article  Google Scholar 

  10. Palomo L, Rubio C, Gérvas J La. comorbilidad en atención primaria. Gac Sanit. 2006;20(Supl 1):182–91.

    Article  PubMed  Google Scholar 

  11. Dalziel WB. Demographics, aging and health care: Is there a crisis? Can Med Assoc J. 1996;155(11):1584–6.

    CAS  Google Scholar 

  12. Pordata. Ageing Índex in Europe. Source: INE, 2011 and Eurostat 2012. Available at http://www.pordata.pt/en/Europe/Ageing+index-1609. Last Assessed on 10th Aug 2016).

  13. Portaria no 277/2014, published 26th December (Defines the normal age to have access to ageing pension for the years 2015 and 2016).

  14. Swartz K. Searching for a balance of responsibilities: OECD countries’ changing elderly assistance policies. Annu Rev Public Health. 2013;34:341–97.

    Article  Google Scholar 

  15. Pinto CG, Teixeira I. Pricing and Reimbursement of Pharmaceuticals in Portugal. Eur J Health Econ. 2002;3(4):267–70.

    Article  Google Scholar 

  16. Pordata. “Current expenditure on healthcare as a % of GDP in Portugal”, available at http://www.pordata.pt/en/Portugal/Current+expenditure+on+healthcare+as+a+percentage+of+GDP-610. Last Assessed on the 10th Aug 2016.

  17. Portaria no 195-D/2015, Diário da República, 1.ª série—No. 125 (Establishes the pharmacotherapeutic groups and subgroups that may be subject to reimbursement and respective copayment strata).

  18. Teixeira, I, Vieira, I. PPRI Pharma Profile Portugal 2008. Pharmaceutical Pricing and Reimbursement Information; Commissioned by the European Commission, DG SANCO and co-funded by the Austrian Federal Ministry of Health, Family and Youth. October 2008. Available at https://ppri.goeg.at/Downloads/Results/Portugal_PPRI_2008.pdf.

  19. Dec-Lei 48-A/2010, Diário da República, 1.ª série—No. 93 (Defines the special regimes for reimbursement).

  20. Legido-Quigley H, Karanikolos M, Hernandez-Plaza S, Freitas C, Bernardo L, Padilla B, et al. Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal. Health Policy. 2016;120:833–9.

    Article  PubMed  Google Scholar 

  21. Portaria no 1320/2010 de 28 de Dezembro, Diário da República, 1.ª série—No. 250 (Defines the “user-fees” to be paid when using different types of health care services).

  22. Wamala S, Merlo J, Boström G, Hogstedt C. Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health. 2007;61(5):409–15.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wamala S, Merlo J, Boström G. Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004–2005. J Epidemiol Community Health. 2006;60(12):1027–33.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sargent-Cox K, Butterwoth P, Anstey KJ. The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study. Soc Sci Med. 2011;73(7):1105–12.

    Article  PubMed  Google Scholar 

  25. Shaw BA, Agahi N, Krause N. Are changes in financial strain associated with changes in alcohol use and smoking among older adults? J Stud Alcohol Drugs. 2011;72:917–25.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Suhrcke M, Stuckler D, Suk JE, Desai M, Senek M, McKee M, et al. The impact of economic crisis on communicable disease transmission and control: a systematic review of the evidence. PLoS ONE. 2011;6(6):e20724.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Costa FA, Pedro AR, Teixeira I, Bragança F, Silva JA, Cabrita J. Primary non-adherence in Portugal: findings and implications. Int J Clin Pharm. 2015;. doi:10.1007/s11096-015-0108-1.

    Google Scholar 

  28. Portaria no 137-A/2012. Diário da República, 1.a série—No. 92 (Establishes the rules for prescribing by Common International Denomination).

  29. European Commission—Directorate General Economic and Financial Affairs. The Economic Adjustment Programme for Portugal. Sixth Review—Autumn 2012. European Economy, Occasional Papers 124; 2012. Available at: http://ec.europa.eu/economy_finance/publications/occasional_paper/2012/pdf/ocp124_en.pdf.

  30. OECD. Health at a glance 2015: OECD indicators. OECD Publishing, Paris; 2015. doi:http://dx.doi.org/10.1787/health_glance-2015-en.

  31. Piette JD, Rosland AM, Silveira MJ, Hayward R, McHorney CA. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse? Patient Prefer Adherence. 2011;5:187–94.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Heisler M, Wagner TH, Piette JD. Patient strategies to cope with high prescription medication costs: who is cutting back on necessities, increasing debt, or underusing medications? J Behav Med. 2005;28(1):43–51.

    Article  PubMed  Google Scholar 

  33. Bambauer KZ, Safran DG, Ross-Degnan DR, Zhang F, Adams AS, Gurwitz J, et al. Depression and cost-related medication nonadherence in medicare beneficiaries. Arch Gen Psychiatry. 2007;64:602–8.

    Article  PubMed  Google Scholar 

  34. Briesacher BA, Gurwitz JH, Soumerai SB. Patients at risk for cost-related medication non-adherence: a review of the literature. Soc Gen Intern Med. 2007;22:864–71.

    Article  Google Scholar 

  35. Zivin K, Ratliff S, Heisler MM, Langa KM, Piette JD. Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. Value Health. 2010;13(4):338–45.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Piette JD, Beard A, Rosland AM, McHorney CA. Beliefs that influence cost-related medication non-adherence among the “haves” and “have nots” with chronic diseases. Patient Prefer Adherence. 2011;5:389–96.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Norris P, Tordoff J, McIntosh B, Laxman K, Chang SY, Karu LT. Impact of prescription charges on people living in poverty: a qualitative study. Res Social Admin Pharm. 2015;. doi:10.1016/j.sapharm.2015.11.001.

    Google Scholar 

  38. Tordoff J, Bagge M, Alli F, Ahmed S, Choong JN, Fu R, et al. Older people’s perceptions of prescription medicine costs and related costs: a pilot study in New Zealand. J Prim Health Care. 2014;6(4):295–303.

    PubMed  Google Scholar 

  39. Barbui C. Access and use of psychotropic medicines in low-resource settings. Epidemiol Psychiatr Sci. 2015;19:1–4 [Epub ahead of print].

    Google Scholar 

  40. Pasina L, Brucato AL, Falcone C, Cucchi E, Bresciani A, Sottocorno M, et al. Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs Aging. 2014;31(4):283–9. doi:10.1007/s40266-014-0163-7.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge Observatório Português dos Sistemas de Saúde (OPSS) for providing the platform for developing this study and the special contributions of other members of the “medicines subgroup”, namely Sérgio Vilão and Fátima Bragança. We also thank all the community pharmacists who actively engaged in patient recruitment and patients who answered the questionnaire.

Funding

The study did not receive any specific funding. Printing costs were supported by OPSS and indirect costs were entirely supported by each of the researchers’ organisations.

Conflicts of interest

The authors declare that they have no financial or other relationships that might lead to a conflict of interest.

Author information

Authors and Affiliations

  1. Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-551, Caparica, Portugal

    Filipa Alves da Costa & Luís Proença

  2. Portuguese Pharmaceutical Society (PPS), Rua da Sociedade Farmacêutica 18, 1169-075, Lisbon, Portugal

    Filipa Alves da Costa

  3. Regional Oncology Registry-South (ROR-Sul), Portuguese Institute of Oncology Lisbon Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal

    Filipa Alves da Costa

  4. Centre for Health Evaluation and Research (CEFAR), Contract Research Organization (CRO), Grupo/Group Associação Nacional das Farmácias (ANF), R. Marechal Saldanha, 1249-069, Lisbon, Portugal

    Inês Teixeira

  5. Departamento de Sócio-farmácia, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal

    Filipa Duarte-Ramos & José Cabrita

  6. Escola Nacional de Saúde Pública, Grupo de Investigação em Políticas e Administração de Saúde, Av. Padre Cruz, 1600-560, Lisbon, Portugal

    Ana Rita Pedro

  7. National Institute of Health Doutor Ricardo Jorge, Department of Infectious Diseases, Reference and Surveillance Unit, Av. Padre Cruz, 1649-016, Lisbon, Portugal

    Cristina Furtado

  8. Prevention Medicine and Public Health Institute, Faculty of Medicine, Lisbon University, Av Professor Egas Moniz, 1449-028, Lisbon, Portugal

    Cristina Furtado

  9. Formifarma, Rua Luiz Marques - Lote 8, Alto dos Gaios, 2765-448, Estoril, Portugal

    José Aranda da Silva

  10. INODES, Av. Padre Cruz, 1649-016, Lisbon, Portugal

    José Aranda da Silva

Authors
  1. Filipa Alves da Costa
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  2. Inês Teixeira
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  4. Luís Proença
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  5. Ana Rita Pedro
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  7. José Aranda da Silva
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  8. José Cabrita
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Corresponding author

Correspondence to Filipa Alves da Costa.

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da Costa, F.A., Teixeira, I., Duarte-Ramos, F. et al. Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal. Int J Clin Pharm 39, 104–112 (2017). https://doi.org/10.1007/s11096-016-0405-3

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  • DOI: https://doi.org/10.1007/s11096-016-0405-3

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