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 in terviews were conducted with 436 subjects in a stratified random sampl ing of elderly respondents to the previously completed 1990 Brazilian Old Age Survey (BOAS). The BOAS sample had been stratified according t o the socioeconomic status (SES) of three communities within Rio de Ja neiro. This study focused on medication use of these subjects as a fun ction of the predisposing, enabling, and need variables which have bee n found in previous research to predict other types of health services utilization (HSU). The enabling variables of access to care were meas ured as patient perceived availability, affordability, and acceptabili ty of both medical and pharmacy services. ANOVA results found differen ces among the different communities in perceived availability and affo rdability of medical and pharmacy services and acceptability of pharma cy services. Subjects from Santa Cruz, the lowest SES area, consistent ly reported lesser availability of services, more difficulties with af fordability but greater perceived acceptability of pharmacy services t han 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. (C) 1997 Published by Elsevie r Science Ltd. All rights reserved.