title: The prevalence of self-reported underuse of medications due to cost for the elderly: results from seven European urban communities.
abstract: BACKGROUND
  The aim of this study was to evaluate the prevalence of self-reported underuse of medications due to procurement costs amongst older persons from seven European urban communities.
  
  
  METHODS
  The data were collected in a cross-sectional study ("ABUEL, Elder abuse: A multinational prevalence survey") in 2009. Randomly selected people aged 60-84 years (n = 4,467) from seven urban communities: Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden) were interviewed. Response rate - 45.2%. Ethical permission was received in each country.
  
  
  RESULTS
  The results indicate that 3.6% (n = 162) of the respondents self-reported refraining from buying prescribed medications due to cost. The highest prevalence of this problem was identified in Lithuania (15.7%, n = 99) and Portugal (4.3%, n = 28). Other countries reported lower percentages of refraining from buying medications (Germany - 2.0%, Italy - 1.6%, Sweden - 1.0%, Greece - 0.6%, Spain - 0.3%). Females refrained more often from buying medications than males (2.6% vs. 4.4%, p < 0.0001). The prevalence of this refraining tended to increase with economic hardship.
  
  
  CONCLUSIONS
  These differences between countries can be only partly described by the financing of health-care systems. In spite of the presence of cost reimbursement mechanisms, patients need to make co-payments (or in some cases to pay the full price) for prescribed medications. This indicates that the purchasing power of people in 10.1186/s12913-015-1089-4 the particular country can play a major role and be related with the economic situation in the country. Lithuania, which has reported the highest refrain rates, had the lowest gross domestic product (at the time of conducting this study) of all participating countries in the study.
  
  
  CONCLUSIONS
  Refraining from buying the prescribed medications due to cost is a problem for women and men in respect to ageing people in Europe. Prevalence varies by country, sex, and economic hardship.
authors.affiliation: Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Kaunas, Lithuania. aurimastan@gmail.com.
authors.forename: Aurima
authors.initials: A
authors.lastname: Stankuniene
authors.affiliation: Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania. mindaugas.stankunas@lsmuni.lt.
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Stankunas
authors.affiliation: Health Service Management Department, Centre for Health Innovation, School of Medicine, Griffith University, Gold Coast, Queensland, Australia. mark.avery@griffith.edu.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Avery
authors.affiliation: Department of Public Health, University of Emden, Emden, Germany. Jutta.lindert@hs-emden-leer.de.|Brandeis University, Waltham, USA. Jutta.lindert@hs-emden-leer.de.
authors.forename: Jutta
authors.initials: J
authors.lastname: Lindert
authors.affiliation: Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Kaunas, Lithuania. ritusinka@gmail.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Mikalauskiene
authors.affiliation: Scientific Technological Area, Centre for Socio Economic Research on Ageing, Italian National Institute of Health and Science on Aging (INRCA), Ancona, Italy. g.Melchiorre@inrca.it.
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Melchiorre
authors.affiliation: Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), University of Granada, Granada, Spain. ftorres@ugr.es.
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres-Gonzalez
authors.affiliation: Department of Sociology, National School of Public Health, Athens, Greece. ioanel@otenet.gr.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ioannidi-Kapolou
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, University of Porto, Porto, Portugal. hbarros@med.up.pt.
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
authors.affiliation: Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Kaunas, Lithuania. arunas.savickas@lsmuni.lt.
authors.forename: Arūnas
authors.initials: A
authors.lastname: Savickas
authors.affiliation: Department of Drug Technology and Social Pharmacy, Lithuanian University of Health Sciences, Kaunas, Lithuania. raimondas.radziunas@lsmuni.lt.
authors.forename: Raimondas
authors.initials: R
authors.lastname: Radziunas
authors.affiliation: Department of Health Sciences, Section of Public Health Science, Mid Sweden University, Sundsvall, Sweden. Joaquim.Soares@miun.se.
authors.forename: Joaquim J F
authors.initials: JJ
authors.lastname: Soares
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005252:Fees, Pharmaceutical / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005858:Germany; D006115:Greece; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends; D006306:Health Surveys; D006801:Humans; D007558:Italy; D008097:Lithuania; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011174:Portugal; D055553:Prescription Drugs / Q000191:economics*; D015995:Prevalence; D012111:Residence Characteristics; D057566:Self Report; D012959:Socioeconomic Factors; D013030:Spain; D013548:Sweden; D014505:Urban Population; D016903:Drug Monitoring
chemical_list: D055553:Prescription Drugs