International Journal of Clinical Pharmacy

, Volume 39, Issue 1, pp 104–112 | Cite as

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

  • Filipa Alves da CostaEmail author
  • Inês Teixeira
  • Filipa Duarte-Ramos
  • Luís Proença
  • Ana Rita Pedro
  • Cristina Furtado
  • José Aranda da Silva
  • José Cabrita
Research Article


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.


Access to health care Aged Equity Financial Health care rationing Health policy Medication adherence Portugal 



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.


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.

Supplementary material

11096_2016_405_MOESM1_ESM.pdf (344 kb)
Supplementary material 1 (PDF 344 kb)


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Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Filipa Alves da Costa
    • 1
    • 2
    • 3
    Email author
  • Inês Teixeira
    • 4
  • Filipa Duarte-Ramos
    • 5
  • Luís Proença
    • 1
  • Ana Rita Pedro
    • 6
  • Cristina Furtado
    • 7
    • 8
  • José Aranda da Silva
    • 9
    • 10
  • José Cabrita
    • 5
  1. 1.Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM)Centro de Investigação Interdisciplinar Egas Moniz (CiiEM)CaparicaPortugal
  2. 2.Portuguese Pharmaceutical Society (PPS)LisbonPortugal
  3. 3.Regional Oncology Registry-South (ROR-Sul)Portuguese Institute of Oncology Lisbon Francisco Gentil (IPOLFG)LisbonPortugal
  4. 4.Centre for Health Evaluation and Research (CEFAR), Contract Research Organization (CRO), Grupo/Group Associação Nacional das Farmácias (ANF)LisbonPortugal
  5. 5.Departamento de Sócio-farmáciaFaculdade de Farmácia da Universidade de LisboaLisbonPortugal
  6. 6.Escola Nacional de Saúde Pública, Grupo de Investigação em Políticas e Administração de SaúdeLisbonPortugal
  7. 7.National Institute of Health Doutor Ricardo Jorge, Department of Infectious DiseasesReference and Surveillance UnitLisbonPortugal
  8. 8.Prevention Medicine and Public Health Institute, Faculty of MedicineLisbon UniversityLisbonPortugal
  9. 9.FormifarmaEstorilPortugal
  10. 10.INODESLisbonPortugal

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