Dissatisfaction with SUS pharmaceutical services and nonadherence to medication use

To analyze the association between user dissatisfaction with the pharmaceutical services provided by the Brazilian Unified Health System (SUS) and nonadherence to medication use by patients with chronic non-communicable diseases.

A cross-sectional study with data from the service evaluation component of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos in Brazil, conducted from July to December 2014. In-person interviews were analyzed with SUS users aged 18 or over who had used medications for hypertension, diabetes, and dyslipidemia and had visited SUS pharmacies in the three months prior to the survey. The dependent variable was medication nonadherence, assessed through three measures: nonadherence due to lack of medication, nonadherence in the past seven days and declared nonadherence. The independent variable was dissatisfaction with the dimensions of pharmaceutical services (timeliness, availability, and accommodation), measured using item response theory. Logistic regression was performed to calculate crude and adjusted odds ratios (OR).

A total of 2,448 users were evaluated. Nonadherence due to lack of medication was 31.6%; in the past seven days was 11.5%; and declared nonadherence 13.0%. Lack of access and forgetfulness were the main reasons for nonadherence in the past seven days. In the adjusted analysis, dissatisfaction with the "timeliness" dimension was associated with nonadherence in the past seven days (OR = 1.489; 95%CI: 1.023-2.168) and the "accommodation" dimension was associated with declared nonadherence (OR = 3.132; 95%CI: 2.266-4.329).

Dissatisfied users were more likely to be nonadherent to medication use across all service dimensions, and dissatisfaction with the availability and accommodation of pharmaceutical services was associated with nonadherence.