Home Delivery Medicament Program: access, inactivity and cardiovascular risk.

Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%).

Home Delivery Medicament Program: access, inactivity and cardiovascular risk / Programa Remédio em Casa: acesso, inatividade e risco cardiovascular / Programa Medicamento en Casa: acceso, inactividad y riesgo cardiovascular

ABSTRACT Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%).

RESUMO Objetivo: verificar causas de inatividade no Programa Remédio em Casa, referidas por usuários de Unidade Básica de Saúde de São Paulo, comparando-as às registradas pelo programa e analisando-as no modelo teórico Conceito de Acesso à Saúde. Métodos: estudo transversal entrevistando 111 usuários inativos; e documental, nos registros do programa. Resultados: metade dos usuários desconhecia a condição de inatividade. Constatadas discrepâncias nas informações usuário versus programa, observando-se diferentes níveis de concordância: Falta de médico e funcionário administrativo 0%; Transferência para outra unidade 25%; Óbito 50%; Opção desistir 50%; Mudança de endereço 57% e Mudança de esquema terapêutico 80%. Observados sentimentos de aceitação do programa pelos usuários. No conceito de acesso à saúde, a inatividade pode ser explicada na dimensão Informação, no grau de assimetria entre o conhecimento do paciente e do profissional de saúde, identificada pelos indicadores: escolaridade, conhecimento e fontes de informação. Conclusões: devido ao baixo nível de escolaridade, o usuário não assimila as informações sobre as etapas do fluxograma do programa, não retorna para a avaliação que garante sua continuidade. Consequentemente, para de receber medicamentos e permanece longo tempo sem tratamento, o que aumenta o risco cardiovascular dos hipertensos (92% da amostra), diabéticos (44%) e dislipidêmicos (31%).

RESUMEN Objetivo: verificar causas de inactividad en el Programa Medicamento en Casa, referidas por usuarios de Unidad Básica de Salud de São Paulo, comparándolas a las registradas por el programa y analizándolas en el modelo teórico Concepto de Acceso a la Salud. Métodos: estudio trasversal entrevistando 111 usuarios inactivos; y documental, en los registros del programa. Resultados: la mitad de los usuario desconocía la condición de inactividad. Constatadas discrepancias en las informaciones usuario versus programa, observándose diferentes niveles de concordancia: Falta de médico y funcionario administrativo 0%; Trasferencia para otra unidad 25%; Óbito 50%; Opción desistir 50%; Cambio de dirección 57% y Cambio de esquema terapéutico 80%. Observados sentimientos de aceptación del programa por los usuarios. En el concepto de acceso a la salud, la inactividad puede ser explicada en la dimensión Información, en el grado de asimetría entre el conocimiento del paciente y del profesional de salud, identificada por los indicadores: escolaridad, conocimiento y fuentes de información. Conclusiones: debido al bajo nivel de escolaridad, el usuario no asimila las informaciones sobre las etapas del diagrama de flujo del programa, no regresa para la evaluación que garantiza su continuidad. Consecuentemente, deja de recibir medicamentos y sigue largo tiempo sin tratamiento, lo que aumenta el riesgo cardiovascular de los hipertensivos (92% de la muestra), diabéticos (44%) y dislipidémicos (31%).