Health equity and the usage of atypical antipsychotics within the Brazilian national health system: findings and implications

ABSTRACT

Background

There is a need to evaluate the health equity of atypical antipsychotics users who obtain their medicines from the Brazilian National Health System (SUS) through the identification of key factors that influence their health status due to concerns with equity of care.

Research design and methods

Cross-sectional study among patients attending state pharmacies in Brazil. Individuals were included if they used atypical antipsychotics, aged ≥18 years, and answered the EQ-5D-3 L questionnaire. Sociodemographic, behavioral, and clinical data were collected. The dependent variable was health status. Associations between the independent variables and the dependent variable were analyzed by adjusting a linear regression model.

Results

Overall, 388 individuals met the eligibility criteria and were included in the analysis. The final multiple linear regression model demonstrated a statistically significant association between VAS and suicide attempts, private care, current antipsychotics, comorbidities, and perceived family support.

Expert Commentary

The study identified several factors both individual and collective that correlate with the health status of atypical antipsychotic users and confirmed the importance of providing medicines for treating psychotic disorders. However, other factors are involved including social support. Our results suggest additional activities and policies are necessary including strategies to address the differences in private and public health care.

KEYWORDS:

• Antipsychotic agents
• psychotic disorders
• schizophrenia spectrum and other psychotic disorders
• health equity
• health status disparities

Author contributions

IFZ contributed to the conception of the study, data analysis and interpretation, and drafting the paper. CMR, HNO, and EAR contributed to the conception and design of the study, data interpretation, and revising the paper. BG, SC, and MLW contributed to successive drafts and the final review of the paper.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethics committee approval

The project was approved by the Ethics and Research Committee of the Federal University of Minas Gerais (COEP-UFMG) on 23 August 2016, under No. 1,691,265, CAAE 57,420,616.9.0000.5149.

Reviewers disclosure

A reviewer on this manuscript has disclosed receiving manuscript or speaker’s fees from Astellas, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Elsevier Japan, Janssen Pharmaceuticals, Kyowa Yakuhin, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Novartis, Otsuka Pharmaceutical, Shionogi, Shire, Tsumura, Wiley Japan, and Yoshitomi Yakuhin, and research grants from Eisai, Mochida Pharmaceutical, Meiji Seika Pharma and Shionogi. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This project was supported directly or indirectly by Capes (Coordenação de Aperfeiçoamento de Pessoal do Nível Superior), CNPq (Conselho Nacional de DesenvolvimentoCientífico e Tecnológico) and Fapemig (Fundação de Amparo à Pesquisa de Minas Gerais).