The impact of economic factors on the realities of outpatient multi-drug treatment of chronic diseases in rural areas.

The reform of the health care system in Poland introduced in 1999 brought not ony a lot of disappointments arising from the failure in performing its basic assumptions, but also from the deterioration in access to medical care by patients coming from the poorest class of the Polish population. The subjects were 209 people at the age of 52-80 years including 149 women and 60 men - inhabitants of rural areas of Lublin province. These were outpatients who attended the Endocrine Clinic in Poniatowa. The studies were conducted with the use of the standardized survey questionnaire. Of all 209 respondents requiring long-term multidrug therapies for chronic diseases, 128 (61.2% of those surveyed) reported episodic or permanent noncompliance to treatment regimens, 90 people (43%) had applied medications in a way at variance with medical recommendations. Among the reasons, economic factors were most often mentioned. Ony 21 respondents (10%) expressed the opinion that they had always possessed sufficient means to buy necessary drugs. Current regulations concerning the refunding of costs of medicines may make effective outpatient treatment of chronic diseases impossible. Almost 61.2% of the polled treated themselves contrary to medical recommendations. In most cases, improper courses of treatment were caused by financial problems.