A method of assessing the quality of pharmaceutical market and industry reports as a source to study access to medicines

This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers.Market and industry reports can be useful in studying access to medicines from a pharmaceutical market perspective. However, many market and industry reports lack some or much of the information required to conduct analyses to study access to medicines and are often not transparent in their data sources and research methodologies. The instrument developed in this study, titled the Pharmaceutical Market and Industry Report Assessment Tool (PIRAT), assesses the quality of pharmaceutical market and industry reports, specifically focusing on the needs of public health researchers, and includes criteria describing the content and quality of the market reports. The assessment tool generates an unweighted score indicating the relative strengths and weaknesses of reports

Medicines and choices. Health policy and individual decision-making

Background and aims: Decisions about choices of medicines are made concerning a population or an individual health care user. Key aims of the thesis were first, to investigate authoritative decision-making in the British National Health Service (NHS) about the access to medicines; second, to investigate the views of health care professionals (HCPs) and patients on making choices about medicine treatment within the medical consultation, including the use of informed consent for medicines; and finally, to seek similarities and differences between the factors found to contribute to each type of decision-making about choices investigated before. Methods: Health policy decision-making was investigated by using a document analysis and in-depth interviews with a range of policy-makers and stakeholders. Individual decision-making was explored by conducting in-depth interviews with doctors, nurses and hospital in- and outpatients from various medical specialities. Informed consent was chosen as an applied model of decision-making where the patient makes a choice. Results: Cost containment and generating politically and legally defensible decisions were strong influences on the process and the outcomes of health policy decisionmaking. Although data about benefit, safety and cost considerations were used as the main legitimisation for the definition of access criteria, several informal and organisational factors were found to have significant influence on decision-making. The lack of information provision about side effects and treatment alternatives made it impossible for patients to make an informed decision about their medication. Informed consent was not regarded as a model to support patients in making informed decisions. Although doctors described patients as a 'partner' in the decisions, an eliciting and implementation of the patients' preferences and values was largely absent. Conclusions: A more consistent application of a minimum moral standard of patient involvement in prescribing decisions could improve individual decision-making. Health policy decisions could benefit from an awareness of the influence of informal factors on health policy decisions

Outpatient cardiovascular diseases and diabetes medicines dispensing in the population with government health insurance in Syria between 2018 and 2019 : a retrospective analysis

Abstract Background Low- and middle-income countries bear the highest burden of non-communicable diseases (NCDs) mortality and morbidity. Syria has undergone an epidemiological transition from infectious diseases to NCDs in the past decades. Despite the high prevalence of cardiovascular diseases (CVDs) and diabetes in Syria, little is known about medicines utilization or prescriptions for these diseases. The aims of this study are to present the patterns and rates of dispensing medicines used for CVDs and diabetes among patients with government health insurance in Syria and examine age, sex, and regional variation in the dispensing of these medicines. Methods Outpatient data from June 2018 to May 2019 on dispensed medicines for 81,314 adults with government health insurance were obtained. The dispensing rate was expressed as the number of defined daily doses (DDDs) per 1000 beneficiaries per day (DID). The DID is a measurement that is used in drug utilization research to control for differences or changes in population size between or within countries. The number of DIDs was adjusted according to beneficiaries’ sex, age, and governorate. Results Beneficiaries received 302.09 DIDs of CVDs medicines and 35.66 DIDs of diabetes medicines, including 0.96 DID of insulin (2.99% of the total of diabetes medicines). CVDs and diabetes medicine dispensing rates were low during the study period and included very low rates of insulin dispensing compared to the dispensing rates of these medicines in other countries in East Mediterranean Region or in Europe. We found lower dispensing rates of CVDs medicines among female beneficiaries (249.59 DIDs) than male beneficiaries (388.80 DIDs). Similarly, the dispensing rates of diabetes medicines among female beneficiaries (29.42 DIDs) were lower than those among male beneficiaries (45.98 DIDs). In addition, there were lower rates of CVDs and diabetes medicines and very low to no dispensing of insulin in some governorates that were partly controlled by the Syrian government compared to other governorates that were completely or mostly controlled by the Syrian government. Conclusions Additional efforts are needed to raise awareness about the prevention and management of CVDs and diabetes especially among females in Syria and consider cultural issues that might influence access to healthcare services. There is a crucial need to address the political and geographical challenges caused by the conflict which have limited access to CVDs and diabetes medicines in some regions in Syria

Barriers to Accessing Medicines among Syrian Asylum Seekers and Refugees in a German Federal State

In Germany, asylum seekers and refugees (AS&Rs) face challenges when accessing healthcare services including medicines. The aim of this study was to explore the barriers to accessing medicines among Syrian AS&Rs in the state of North Rheine-Westphalia, and to provide an understanding of their perspectives towards taking medicines that contain alcohol or pork products. This study is based on a cross-sectional survey using a combination of sampling methods. We used descriptive statistics to analyze quantitative data. Participants’ answers to an open-ended question yielded qualitative data that were categorized based on the thematic areas they discussed or addressed. Among the 1641 respondents, language barriers had more of an effect on the access to medicines than any other factor studied. The effect of language barriers on access to medicines was more pronounced for female participants, those who were older than 50 years, and participants who had chronic diseases in comparison to the other groups of participants. Male participants and those younger than 50 years of age showed more acceptance towards taking medicines that contain alcohol or pork products. Based on our results, we recommend providing more support for AS&Rs to learn the German language, particularly for female refugees, older refugees, and those with chronic diseases or disabilities. We also recommend providing translated medical leaflets for patients who wish to receive them in their native language. Healthcare providers should try to consider the special conditions of AS&Rs patients and take into account their perspectives about treatments and diseases

Study protocol for a cluster-randomized controlled trial of an NCD access to medicines initative: Evaluation of Novartis Access in Kenya

INTRODUCTION: Novartis recently launched Novartis Access, an initiative to provide a basket of reduced price medicines for non-communicable diseases (NCDs) to be sold through the public and private nonprofit sectors in programme countries. This study will evaluate the impact of Novartis Access on the availability and price of NCD medicines at health facilities and households in Kenya, the first country to receive the programme. METHODS: This study will be a cluster randomised controlled trial. 8 counties in Kenya will be randomly assigned to the intervention or control group using a covariate constrained randomisation method to maximise balance on demographic and health characteristics. In intervention counties, public and private non-profit health facilities will be able to order Novartis Access NCD medicines from the Mission for Essential Drugs and Supplies (MEDS). Data will be collected from a random sample of 384 health facilities and 800 households at baseline, midline after 1-year of intervention, and end-line after 2 years. Quarterly surveillance data will also be collected from health facilities and a subsample of households through phone-based interviews. Households will be eligible if at least one resident has been previously diagnosed and prescribed a medicine for an NCD addressed by Novartis Access, including hypertension and diabetes. The primary outcomes will be availability and price of NCD medicines at health facilities, and availability, price, and expenditures on NCD medicines at households. Impacts will be estimated using intention-to-treat analysis. ETHICS AND DISSEMINATION: This protocol was approved by the Institutional Review Boards at Strathmore University and at Boston University. Informed consent will be obtained from all participants at the start of the trial. The findings of the trial will be disseminated through peer-reviewed journals, international conferences, and meetings and events organised with local stakeholders

Comparative analysis of essential medicines for cardiovascular diseases in countries of the WHO Eastern Mediterranean Region

Adequate access to essential medicines for cardiovascular disease is necessary to address the high cardiovascular disease burden in countries of the Eastern Mediterranean Region of the World Health Organization (WHO). This study compared the cardiovascular disease medicines included in the WHO Model Essential Medicines List with those in the national essential medicines lists of 19 countries of the Region. Data were extracted on the number of cardiovascular medicines and dosage forms in the national lists and compared with those on the WHO Model List (24 medicines in total and 48 dosage forms). Factors associated with the number of essential cardiovascular medicines on the national lists (burden of cardiovascular diseases and health expenditure per capita) were assessed. The number of medicines from 6 therapeutic groups of cardiovascular medicines listed in the national lists but not in the core WHO Model List were evaluated