Camila Nascimento Monteiro

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003–2008

BackgroundAccess to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the “Smiling Brazil” Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003.MethodData was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored.ResultsOverall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups.ConclusionsThe Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.

Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil

INTRODUCTION Since 2003, the access to medication has been increasing in Brazil and particularly in São Paulo. The present study aimed to analyze the access to medication obtained in the public sector and the socioeconomic differences in this access in 2003 and 2008. Also, we explored the difference in access to medication from 2003 to 2008. METHOD Data were obtained from two cross-sectional population-based household surveys from São Paulo, Brazil (ISA-Capital 2003 and ISA-Capital 2008). Concentration curve and concentration index were calculated to analyze the associations between socioeconomic factors and access to medication in the public sector. Additionally, the differences between 2003 and 2008 regarding socioeconomic characteristics and access to medication were studied. RESULTS Access to medication was 89.55% in 2003 and 92.99% in 2008, and the proportion of access to medication did not change in the period. Access in the public sector increased from 26.40% in 2003 to 48.55% in 2008 and there was a decrease in the concentration index between 2003 and 2008 in access to medication in the public sector. CONCLUSIONS The findings indicate an expansion of Brazilian Unified Health System (Sistema Único de Saúde ) users, with the inclusion of people of higher socioeconomic position in the public sector. As the SUS gives more support to people of lower socioeconomic position in terms of medication provision, the SUS tends to equity. Nevertheless, universal coverage for medication and equity in access to medication in the public sector are still challenges for the Brazilian public health system.

Acesso e uso de serviços de saúde pela população brasileira, Pesquisa Nacional de Saúde 2013

ABSTRACT OBJECTIVE To analyze the use of health services in the Brazilian population by sociodemographic factors, according to data from the 2013 Brazilian National Health Survey. METHODS The study analyzed data from 205,000 Brazilian citizens in all age groups who participated in the Brazilian National Health Survey, a cross-sectional study carried out in 2013. Prevalence and confidence intervals were estimated for indicators related to access to and use of health services according to age group, level of education of head of household, and Brazilian macroregions. RESULTS Among individuals who sought health services in the two weeks prior to the survey, 95.3% (95%CI 94.9–95.8) received care in their first visit. Percentages were higher in the following groups: 60 years of age and over; head of household with complete tertiary education; living in the South and Southeast regions. In addition, 82.5% (95%CI 81.2–83.7) of individuals who received health care and prescriptions were able to obtain all the necessary medicines, 1/3 of them from SUS. Less than half the Brazilian population (44.4%; 95%CI 43.8–45.1) visited a dentist in the 12 months prior to the survey, with smaller percentages among the following groups: 60 years of age or older; head of household with no education or up to incomplete elementary; living in the North region of Brazil. CONCLUSIONS People living in the South and Southeast regions still have greater access to health services, as do those whose head of household has a higher level of education. The (re)formulation of health policies to reduce disparities should consider differences encountered between regions and social levels.OBJETIVO Descrever o uso de servicos de saude na populacao brasileira segundo fatores sociodemograficos, de acordo com dados da Pesquisa Nacional de Saude, 2013. METODOS Foram analisados dados referentes a 205 mil brasileiros, de todas as faixas etarias, que participaram da Pesquisa Nacional de Saude, estudo transversal conduzido em 2013. Calcularam-se as prevalencias e seus […]

Adesão ao tratamento farmacológico de pacientes hipertensos entre participantes do Programa Remédio em Casa

OBJECTIVE to analyze adherence to medication and associated among factors hypertensive individuals taking part in the Medicine at Home Programme. METHODS this was a cross-sectional study using a questionnaire administered to patients with full access to medication participating in the São Paulo City Health Departments Medicine at Home Programme; treatment adherence was analyzed according to sociodemographic and behavioral characteristics using Poisson regression. RESULTS 106 patients with arterial hypertension and with full access to medication were interviewed and 80.2% had high adherence; there were no significant differences (p>0.05) between adhering and non-adhering participants with regard to sociodemographic, behavioral or clinical characteristics. CONCLUSION with adequate provision of health care and full access to medicine, sociodemographic, behavioral and clinical factors did not influence adherence to medicine indicating that health service organization and health policies play a fundamental role in controlling hypertension.Resumo OBJETIVO: analisar a adesao ao tratamento farmacologico e fatores associados entre portadores de hipertensao arterial participantes do Programa Remedio em Casa. METODOS: estudo transversal, com aplicacao de questionario junto a pacientes com pleno acesso a medicamentos, usuarios do Programa Remedio em Casa da Secretaria Municipal da Saude de Sao Paulo; a analise da adesao ao tratamento segundo caracteristicas sociodemograficas e comportamentais foi realizada a partir da regressao de Poisson. RESULTADOS: foram entrevistados 106 portadores de hipertensao arterial com pleno acesso a medicamentos e 80,2% deles apresentaram alta adesao terapeutica; participantes aderentes e nao aderentes nao apresentaram diferencas significativas (p>0,05) quanto as caracteristicas sociodemograficas, comportamentais e clinicas. CONCLUSAO: com adequada assistencia, cuidados de saude e pleno acesso a medicamentos, os fatores sociodemograficos, comportamentais e clinicos nao influenciaram a determinacao da adesao ao tratamento, indicando que a organizacao dos servicos e as politicas de saude sao fundamentais no controle da hipertensao arterial.

Cobertura vacinal e utilização do SUS para vacinação contra gripe e pneumonia em adultos e idosos com diabetes autorreferida, no município de São Paulo, 2003, 2008 e 2015

OBJECTIVE to estimate the vaccination coverage against influenza and pneumonia and to analyze the utilization of Brazilian National Health System-SUS for vaccination in adults and elderly with self-reported diabetes in São Paulo, Brazil, in 2003, 2008 and 2015. METHODS Cross-sectional studies with data from the ISA-Capital (population-based household surveys). RESULTS 3,357, 3,271 and 4,043 were interviewed in 2003, 2008 and 2015; the prevalence of diabetes mellitus were 5.0% (2003), 6.4% (2008) and 7.7% (2015); fewer than half of people with diabetes, vaccinated against influenza (47.2%) and pneumonia (17.9%) in 2003, with a small increase in 2015 (59.2% and 26.1%, respectively); the majority of people who are vaccinated against influenza and pneumonia used SUS, 88.7% (2003) and 97.2% (2015) for influenza; 84.7% (2003) and 94.5% (2015) for pneumonia, without difference among age, sex, education level and ethnicity. CONCLUSION despite the low vaccination coverage against influenza and pneumonia in the population with diabetes mellitus since 2003 the utilization of SUS to vaccination has been progressively expanding.

Utilização de medicamentos genéricos no município de São Paulo em 2003: estudo de base populacional

OBJETIVO: analisar a utilizacao e a percepcao sobre medicamentos genericos pela populacao com diabetes e hipertensao na cidade de Sao Paulo, considerando-se a Politica de Medicamentos Genericos no Brasil. METODOS: estudo transversal com dados do Inquerito de Saude do Municipio de Sao Paulo (ISA-Capital), coletados em 2003; foi analisado o conhecimento sobre medicamentos genericos e a associacao entre utilizacao desses medicamentos e caracteristicas sociodemograficas e socioeconomicas. RESULTADOS: foram incluidos 603 participantes; entre hipertensos e diabeticos, foi encontrada baixa utilizacao de medicamento generico (33,3% e 26,3%, respectivamente) e a principal vantagem atribuida ao medicamento generico foi o baixo custo (71,0% e 71,1%, respectivamente); nao houve diferenca estatisticamente significativa entre uso de medicamento generico e idade, sexo ou escolaridade. CONCLUSAO: o baixo custo e nao haver diferenca entre uso do generico e escolaridade reforcam a importância do medicamento generico para a promocao da equidade e do acesso universal a medicamentos.OBJECTIVE to analyze the use and perception of generic drugs by people with diabetes and hypertension in São Paulo City, Brazil, considering the Brazilian Generic Drug Policy. METHODS this was a cross-sectional study using data from a household health survey (ISA-Capital) in 2003; analysis was performed on knowledge regarding generic drugs and on the association between their use and sociodemographic and socio-economic characteristics. RESULTS 603 people with hypertension and diabetes were included in the study, low use of generic drugs was found (33.3% and 26.3, respectively) and low cost was the major reported advantage of generic drugs (71.0% and 71.1%, respectively); there was no statistically significant difference between the use of generic medication and age, sex or schooling. CONCLUSION low cost and there being no difference between generic drug use and education level strengthen the importance of generic drugs for promoting equity and universal access to medication.

Cobertura de serviços públicos de saúde para gastos com medicamentos e vacinas na população com diabetes mellitus

This study analyzed the coverage by the public health service of expenses with medication and vaccines for the adult population of São Paulo with self-reported diabetes mellitus in 2003 and the implications for access to medicines and vaccination campaigns programs. Data were collected by the Multicenter Health Survey of São Paulo. The Unified Health System (SUS) was widely used by the population for vaccination against influenza and pneumonia and there was significant private sector participation for coverage of expenses with medication, with an estimated coverage of 38% by SUS. There were no significant differences in the prevalence of use of public services for vaccination among the categories of variables studied, suggesting a universal distribution of vaccination by the public health service. Unlike vaccinations, in 2003 the coverage of medication expenses by the public health service was recent in Brazil, which may explain the low level of coverage. An analysis of coverage of vaccination and medication expenses in diabetes mellitus population since 2003 may contribute to be the basis for policies to broaden access of the population to health services.This study analyzed the coverage by the public health service of expenses with medication and vaccines for the adult population of Sao Paulo with self-reported diabetes mellitus in 2003 and the implications for access to medicines and vaccination campaigns programs. Data were collected by the Multicenter Health Survey of Sao Paulo. The Unified Health System (SUS) was widely used by the population for vaccination against influenza and pneumonia and there was significant private sector participation for coverage of expenses with medication, with an estimated coverage of 38% by SUS. There were no significant differences in the prevalence of use of public services for vaccination among the categories of variables studied, suggesting a universal distribution of vaccination by the public health service. Unlike vaccinations, in 2003 the coverage of medication expenses by the public health service was recent in Brazil, which may explain the low level of coverage. An analysis of coverage of vaccination and medication expenses in diabetes mellitus population since 2003 may contribute to be the basis for policies to broaden access of the population to health services.