Emmerick Isabel Cristina Martins, Luiza Vera Lucia, Camacho Luiz Antonio Bastos, Vialle-Valentin Catherine, Ross-Degnan Dennis
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA.
Center for Pharmaceutical Policies, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, (NAF/ENSP/Fiocruz), Rua Leopoldo Bulhões 1480, Manguinhos, 21041 210, Rio de Janeiro, RJ, Brazil.
Int J Equity Health. 2015 Oct 31;14:115. doi: 10.1186/s12939-015-0254-z.
Access to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries.
This was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported.
A chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 - 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector.
The nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access.
药品可及性是卫生政策面临的主要挑战之一。拉丁美洲和加勒比地区（LAC）在药品方面高额的自付费用是获得负担得起的非传染性疾病护理的重要障碍。本文旨在确定中美洲三个国家中患有确诊慢性病的家庭成员在药品可及性方面的关键障碍。
这是一项横断面分析研究，基于三项采用通用方法的家庭调查数据。我们研究了与以下方面相关的因素：（1）在正规卫生系统中向经过培训的临床医生寻求慢性病护理，以及（2）获取所报告慢性病所需的所有药品。
2761户家庭中有29.8%（827户）报告患有慢性病，在尼加拉瓜、洪都拉斯和危地马拉分别为47.0%、30.7%和11.8%。报告的三种主要慢性病是高血压、关节炎和糖尿病。在正规卫生系统中寻求护理的比例从尼加拉瓜的73.4%到洪都拉斯的83.1%不等，而完全获得药品的比例从危地马拉的71.6%到洪都拉斯的88.0%不等。在正规卫生系统中寻求护理的主要相关因素包括地理位置、户主性别、西班牙语读写能力、患者年龄、感知健康状况、对公共部门护理质量的感知、家庭经济水平以及拥有医疗保险。在正规卫生系统中寻求护理是完全获得药品的主要双变量相关因素（比值比：4.3，95%置信区间2.6 - 7.0）。当户主年龄超过65岁、免费获得药品、家庭社会经济地位较高以及在私营部门寻求医疗护理时，完全获得药品的几率显著更高。
卫生系统的性质在药品可及性方面起着重要作用。当有可用且有效运作的公共设施，或私营部门护理负担得起时，可及性会更好。因此，了解人们在特定环境中如何寻求护理并加强关键的卫生系统组成部分将是改善药品可及性的重要策略，特别是对于那些药品可及性差风险高的人群。
