Estratégias para promover o acesso a medicamentos de interesse em saúde pública : revisão estruturada da literatura

RESUMEN: Objetivo: Identificar estrategias orientadas a favorecer el acceso a medicamentos de interés en salud pública, de alto costo o protegidos por patentes, posiblemente aplicables al contexto colombiano. Metodología: revisión estructurada en PubMed/Medline, utilizando los términos MeSH: “health services accessibility”, “pharmaceutical preparations”, “policy”, con filtros para artículos publicados en inglés y español, entre 2012 y 2017. Se incluyeron aquellos con información sobre estrategias o políticas que favorecieran el acceso a medicamentos de interés en salud pública de alto costo o protegidos por patentes. Las estrategias identificadas fueron agrupadas acorde con las cinco dimensiones del acceso a la atención en salud y medicamentos definidas por la Organización Mundial de la Salud: disponibilidad, asequibilidad, accesibilidad, aceptabilidad y calidad. Resultados: Se identificaron 62 artículos, de los cuales se incluyeron 18 y se consideraron 5 referencias adicionales. Se reconocieron 30 estrategias, distribuidas y clasificadas según las dimensiones del acceso: disponibilidad y asequibilidad, 15; accesibilidad, 6; aceptabilidad, 6; calidad, 2; estrategia transversal, 1. Conclusiones: Se identificaron estrategias claves para favorecer el acceso a medicamentos de interés en salud pública de alto costo o protegidos por patentes, dentro de las que se encuentran las negociaciones centralizadas de precios; el apoyo financiero público para la investigación, desarrollo y producción nacional de medicamentos genéricos; la aplicación de las flexibilidades del acuerdo sobre los “Aspectos de los derechos de propiedad intelectual relacionados con el comercio” y la implementación de programas de asistencia.ABSTRACT: Objective: To identify strategies aimed at promoting access to high-cost or patent-protected medicines of interest in public health, possibly applicable to the Colombian context. Methodology: structured review in PubMed/Medline, using the MeSH terms: “health services accessibility”, “pharmaceutical preparations”, “policy”, with filters for articles published in English and Spanish, between 2012 and 2017. Studies with information on strategies or policies that favored access to highcost or patent-protected drugs of interest in public health were included. The strategies identified were grouped according to the five dimensions of access to health care and medicines defined by the World Health Organization: availability, affordability, accessibility, acceptability and quality. Results: 62 articles were identified, of which 18 were included, and 5 additional references were considered. 30 strategies were recognised, distributed and classified according to the dimensions of access: availability and affordability, 15; accessibility, 6; acceptability, 6; quality, 2; cross-cutting strategy, 1. Conclusions: Key strategies were identified to favor access to high-cost or patentprotected medicines of interest in public health, including centralized price negotiations; public financial support for national research, development and production of generic medicines; the application of the flexibilities of the agreement on “Aspects of intellectual property rights related to trade” and the implementation of care programs

Estrategias para promover el acceso a medicamentos de interés en salud pública: revisión estructurada de la literatura

Objective: To identify strategies aimed at promoting access to high-cost or patent-protected medicines of interest in public health, possibly applicable to the Colombian context. Methodology: structured review in PubMed/Medline, using the MeSH terms: “health services accessibility”, “pharmaceutical preparations”, “policy”, with filters for articles published in English and Spanish, between 2012 and 2017. Studies with information on strategies or policies that favored access to high-cost or patent-protected drugs of interest in public health were included. The strategies identified were grouped according to the five dimensions of access to health care and medicines defined by the World Health Organization: availability, affordability, accessibility, acceptability and quality. Results: 62 articles were identified, of which 18 were included, and 5 additional references were considered. 30 strategies were recognised, distributed and classified according to the dimensions of access: availability and affordability, 15; accessibility, 6; acceptability, 6; quality, 2; cross-cutting strategy, 1. Conclusions: Key strategies were identified to favor access to high-cost or patent- protected medicines of interest in public health, including centralized price negotiations; public financial support for national research, development and production of generic medicines; the application of the flexibilities of the agreement on “Aspects of intellectual property rights related to trade” and the implementation of care programs.Objetivo: Identificar estratégias destinadas a favorecer o acesso a medicamentos de interesse em saúde pública, de alto custo ou protegidos por patentes, possivelmente aplicáveis ao contexto colombiano. Metodologia: revisão estruturada no PubMed/Medline, usando os termos MeSH: “health services accessibility”, “pharmaceutical preparations”, “policy”, com filtros para artigos publicados em inglês e espanhol, entre 2012 e 2017. Foram incluídos aqueles com informações sobre estratégias ou políticas que favoreciam o acesso a medicamentos de interesse em saúde pública de alto custo ou protegidos por patentes. As estratégias identificadas foram agrupadas de acordo com as cinco dimensões de acesso aos cuidados de saúde e medicamentos definidas pela Organização Mundial da Saúde: disponibilidade, alcançabilidade, acessibilidade, aceitabilidade e qualidade. Resultados: Foram identificados 62 artigos, dos quais 18 foram incluídos e 5 referências adicionais foram consideradas. 30 estratégias foram identificadas, distribuídas e classificadas de acordo com as dimensões do acesso: disponibilidade e alcançabilidade, 15; acessibilidade, 6; aceitabilidade, 6; qualidade 2; estratégia transversal, 1. Conclusões: Foram identificadas estratégiaschave para favorecer o acesso a medicamentos de interesse em saúde pública de alto custo ou protegidos por patentes, dentro das quais estão as negociações centralizadas de preços; o apoio financeiro público à pesquisa, desenvolvimento e produção nacional de medicamentos genéricos; a aplicação das flexibilidades do acordo sobre “Aspectos dos direitos de propriedade intelectual relacionados ao comércio” e a implementação de programas de assistência.Objetivo: Identificar estrategias orientadas a favorecer el acceso a medicamentos de interés en salud pública, de alto costo o protegidos por patentes, posiblemente aplicables al contexto colombiano. Metodología: revisión estructurada en PubMed/Medline, utilizando los términos MeSH: “health services accessibility”, “pharmaceutical preparations”, “policy”, con filtros para artículos publicados en inglés y español, entre 2012 y 2017. Se incluyeron aquellos con información sobre estrategias o políticas que favorecieran el acceso a medicamentos de interés en salud pública de alto costo o protegidos por patentes. Las estrategias identificadas fueron agrupadas acorde con las cinco dimensiones del acceso a la atención en salud y medicamentos definidas por la Organización Mundial de la Salud: disponibilidad, asequibilidad, accesibilidad, aceptabilidad y calidad. Resultados: Se identificaron 62 artículos, de los cuales se incluyeron 18 y se consideraron 5 referencias adicionales. Se reconocieron 30 estrategias, distribuidas y clasificadas según las dimensiones del acceso: disponibilidad y asequibilidad, 15; accesibilidad, 6; aceptabilidad, 6; calidad, 2; estrategia transversal, 1. Conclusiones: Se identificaron estrategias claves para favorecer el acceso a medicamentos de interés en salud pública de alto costo o protegidos por patentes, dentro de las que se encuentran las negociaciones centralizadas de precios; el apoyo financiero público para la investigación, desarrollo y producción nacional de medicamentos genéricos; la aplicación de las flexibilidades del acuerdo sobre los “Aspectos de los derechos de propiedad intelectual relacionados con el comercio” y la implementación de programas de asistencia

Towards a theoretical model on medicines as a health need

Medicines are considered one of the main tools of western medicine to resolve health problems. Currently, medicines represent an important share of the countries' healthcare budget. In the Latin America region, access to essential medicines is still a challenge, although countries have established some measures in the last years in order to guarantee equitable access to medicines. A theoretical model is proposed for analysing the social, political, and economic factors that modulate the role of medicines as a health need and their influence on the accessibility and access to medicines. The model was built based on a narrative review about health needs, and followed the conceptual modelling methodology for theory-building. The theoretical model considers elements (stakeholders, policies) that modulate the perception towards medicines as a health need from two perspectives - health and market - at three levels: international, national and local levels. The perception towards medicines as a health need is described according to Bradshaw's categories: felt need, normative need, comparative need and expressed need. When those different categories applied to medicines coincide, the patients get access to the medicines they perceive as a need, but when the categories do not coincide, barriers to access to medicines are created. Our theoretical model, which holds a broader view about the access to medicines, emphasises how power structures, interests, interdependencies, values and principles of the stakeholders could influence the perception towards medicines as a health need and the access to medicines in Latin American countries