title: Effects of economic recession on elderly patients' perceptions of access to health care and medicines in Portugal.
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.
authors.affiliation: 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. alvesdacosta.f@gmail.com.|Portuguese Pharmaceutical Society (PPS), Rua da Sociedade Farmacêutica 18, 1169-075, Lisbon, Portugal. alvesdacosta.f@gmail.com.|Regional Oncology Registry-South (ROR-Sul), Portuguese Institute of Oncology Lisbon Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal. alvesdacosta.f@gmail.com.
authors.forename: Filipa Alves
authors.identifier: http://orcid.org/0000-0003-0562-2514
authors.initials: FA
authors.lastname: da Costa
authors.affiliation: 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.
authors.forename: Inês
authors.initials: I
authors.lastname: Teixeira
authors.affiliation: Departamento de Sócio-farmácia, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Duarte-Ramos
authors.affiliation: 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.
authors.forename: Luís
authors.initials: L
authors.lastname: Proença
authors.affiliation: Escola Nacional de Saúde Pública, Grupo de Investigação em Políticas e Administração de Saúde, Av. Padre Cruz, 1600-560, Lisbon, Portugal.
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Pedro
authors.affiliation: National Institute of Health Doutor Ricardo Jorge, Department of Infectious Diseases, Reference and Surveillance Unit, Av. Padre Cruz, 1649-016, Lisbon, Portugal.|Prevention Medicine and Public Health Institute, Faculty of Medicine, Lisbon University, Av Professor Egas Moniz, 1449-028, Lisbon, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Furtado
authors.affiliation: Formifarma, Rua Luiz Marques - Lote 8, Alto dos Gaios, 2765-448, Estoril, Portugal.|INODES, Av. Padre Cruz, 1649-016, Lisbon, Portugal.
authors.forename: José Aranda
authors.initials: JA
authors.lastname: da Silva
authors.affiliation: Departamento de Sócio-farmácia, Faculdade de Farmácia da Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Cabrita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057172:Economic Recession / Q000639:trends*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000639:trends*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010465:Perception; D011174:Portugal / Q000453:epidemiology
keywords: Access to health care; Aged; Equity; Financial; Health care rationing; Health policy; Medication adherence; Portugal