Diferencias institucionales en el insuficiente acceso efectivo a medicamentos prescritos en instituciones prestadoras de servicios de salud en Perú: Análisis de la Encuesta Nacional de Satisfacción de Usuarios de los Servicios de Salud (ENSUSALUD 2014)

Edward Mezones-Holguin; Risof Solis-Cóndor; Vicente Aleixandre Benites-Zapata; Gladys Garnica-Pinazo; Edith Márquez-Bobadilla; Martín Tantaleán-Del-Águila; José Villegas-Ortega; Flor de María Philipps-Cuba

doi:10.17843/rpmesp.2016.332.2197

Authors

Edward Mezones-Holguin Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud (SUSALUD), Lima, Perú. Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
Risof Solis-Cóndor Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud (SUSALUD), Lima, Perú. Facultad de Medicina, Universidad Privada de San Martin de Porras, Lima, Perú.
Vicente Aleixandre Benites-Zapata Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú. Unidad Funcional de Cobertura y Siniestros, Fondo Intangible Solidario en Salud (FISSAL)-Seguro Integral de Salud (SIS), Lima, Perú.
Gladys Garnica-Pinazo Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud (SUSALUD), Lima, Perú.
Edith Márquez-Bobadilla Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud (SUSALUD), Lima, Perú.
Martín Tantaleán-Del-Águila Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud (SUSALUD), Lima, Perú. Unidad Funcional de Cobertura y Siniestros, Fondo Intangible Solidario en Salud (FISSAL)-Seguro Integral de Salud (SIS), Lima, Perú.
José Villegas-Ortega Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud (SUSALUD), Lima, Perú.
Flor de María Philipps-Cuba Alta Dirección, Superintendencia Nacional de Salud (SUSALUD), Lima, Perú. Escuela de Postgrado, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.

DOI:

https://doi.org/10.17843/rpmesp.2016.332.2197

Keywords:

Drug prescriptions, Equity in access, Universal access to health care services, Health care quality, access, and evaluation, poverty, Peru

Abstract

Objectives. To estimate the prevalence of ineffective access to drugs (IAD) and associated factors in patients receiving a prescription in an outpatient clinic in Peru. Materials and Methods. We performed a secondary data-analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD 2014), a two-stage population-based study carried out in health care centers of the Ministry of Health and Regional Governments (MOHRG), Social Security (EsSalud), Armed Forces and Police (AFP) and the private sector across all 25 regions of Peru. IAD was defined as incomplete or no dispensing of any prescribed medication in the health care center pharmacy. Generalized linear models with Poisson distribution for complex survey sampling were fit to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Results. Out of 13,360 participants, 80.9 % (95% CI: 79.9-81.8) had an active prescription, and of those, 90.8 % (95% CI: 90.1-91.6) sought their medications in a health care center pharmacy, where 30.6 % (95% CI 28.8-32.4) had IAD. In the multiple regression model, receiving medical attention in the MOHRG (PR 4.8; 95%CI: 3.5-6.54) or AFP (PR: 3.2; 95%CI: 2.3-4.5), being over 60 years old (PR: 1.17; 95%CI: 1.04-1.34) and being in the poorest income quintile (PR: 1.05; 95%CI: 1.05-1.41) increased IAD. Furthermore, in contrast to seeking care for pregnancy or other routine control, IAD was also more common for medical consultation for diseases diagnosed in the last 15 days (PR: 1.37; 95% CI: 1.05-1.79) or more than 15 days prior (PR: 1.51; 95% CI: 1.16-1.97). Conclusions. In Peru, IAD is associated with the provider institution, older age, poverty and the reason for medical consultation. We suggest strategies to promote access to medicines, especially in the most disadvantaged segments of the Peruvian population.