Perceived access to care and medication use among ambulatory elderly in Rio de Janeiro, Brazil

This study examined physician and non-physician prescribed medication use of a growing segment of Brazilian society--the elderly. Personal interviews were conducted with 436 subjects in a stratified random sampling of elderly respondents to the previously completed 1990 Brazilian Old Age Survey (BOAS). The BOAS sample had been stratified according to the socioeconomic status (SES) of three communities within Rio de Janeiro. This study focused on medication use of these subjects as a function of the predisposing, enabling, and need variables which have been found in previous research to predict other types of health services utilization (HSU). The enabling variables of access to care were measured as patient perceived availability, affordability, and acceptability of both medical and pharmacy services. ANOVA results found differences among the different communities in perceived availability and affordability of medical and pharmacy services and acceptability of pharmacy services. Subjects from Santa Cruz, the lowest SES area, consistently reported lesser availability of services, more difficulties with affordability but greater perceived acceptability of pharmacy services than those from the highest SES area. Multivariate regressions modeling both prescribed and non-prescribed medication use for the three areas found that the access-oriented HSU framework was much more effective in explaining the variance in medication use for the lowest SES area (45% and 48% for prescribed and non-prescribed use, respectively) than for the highest SES area where only 16% and 18% of prescribed and non-prescribed medication use was explained.