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Donker EM, Spitaleri Timpone P, Brinkman DJ, Richir MC, Papaioannidou P, Likic R, Sanz EJ, Christiaens T, Costa JN, De Ponti F, Gatti M, Böttiger Y, Kramers C, Pandit R, van Agtmael MA, Tichelaar J. The European List of Key Medicines for Medical Education: A Modified Delphi Study. Clin Pharmacol Ther 2024; 115:515-524. [PMID: 38062784 DOI: 10.1002/cpt.3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Abstract
Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.
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Affiliation(s)
- Erik M Donker
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Pietro Spitaleri Timpone
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - David J Brinkman
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Milan C Richir
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paraskevi Papaioannidou
- Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert Likic
- Unit of Clinical Pharmacology, Department of Internal Medicine, University Hospital Centre Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Emilio J Sanz
- School of Health Science, Universidad de La Laguna, and Hospital Universitario de Canarias (SCS), Santa Cruz de Tenerife, Spain
| | - Thierry Christiaens
- Unit of Clinical Pharmacology, Department of Fundamental and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - João N Costa
- Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
- Instituto de Medicina Molecular, Lisbon, Portugal
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Milo Gatti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Ylva Böttiger
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Cornelis Kramers
- Department of Clinical Pharmacy, CWZ, Nijmegen, The Netherlands
- Department of Internal Medicine, Radboud University, Nijmegen, The Netherlands
| | - Rahul Pandit
- Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel A van Agtmael
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
- Interprofessional Collaboration and Medication Safety at the Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
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Petrella A, Fortinguerra F, Cangini A, Pierantozzi A, Trotta F. Access and use of WHO essential medicines in Italy. Front Public Health 2023; 11:1211208. [PMID: 37881343 PMCID: PMC10595003 DOI: 10.3389/fpubh.2023.1211208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
Background Many countries use the WHO Essential Medicines List (EML) as a guide for health policy choices to promote the efficient use of healthcare resources or adopt the concept of essential medicines (EMs) to develop their own national list of essential medicines. The aim of this study is to analyse the availability and use of medicines included in the 22nd WHO EML in Italy. Methods Using the ATC code (5th level), a comparison was made between the medicines included in the WHO EML and those retrieved from the Italian Medicines Agency (AIFA) database. The availability (regulatory and reimbursement status) of EMs, as well as the market share in expenditure (million euros) and consumption [measured in WHO-defined daily doses (DDDs)], compared to all reimbursed medicines in 2021, were analysed. Results In 2021, approximately 85.2% (n = 414) of medicines included in the WHO EML were commonly marketed in Italy. Of these, 396 EMs were fully reimbursed by the Italian National Healthcare Service (INHS), corresponding to 81.5% (396/486) of the WHO EML, while the remaining 18.5% (90/486) were neither authorised (n = 72) nor reimbursed (n = 18). The study found a low coverage for anti-parasitic, insecticides, and repellent products (ATC P) in addition to medicines for the genitourinary system and sex hormones (ATC G). Even though medicines on the WHO EML, including therapeutic alternatives, accounted for ~48.5% of the expenditure for medicines reimbursed by INHS, the list covered 74% of all national drug consumed. Novel high-cost therapies indicated in high-prevalence diseases and rare conditions, mostly antineoplastic and immune-modulating agents (ATC L) not included in the WHO EML, were also guaranteed. Conclusions In Italy, high coverage of EMs was found. It was largely reimbursed by the INHS, even when compared to other European countries. Essential medicines represented a high percentage of the overall expenditure and consumption in Italy. The WHO EML could be an important tool to guide the health policy choices of high-income countries, although a more frequent update and easier access to information on rejected medicines are needed.
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Ally MZ, Woods H, Adekoya I, Bali A, Persaud N. Acceptability of a short list of essential medicines to patients and prescribers: Multimethod study. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e204-e214. [PMID: 35831082 PMCID: PMC9842143 DOI: 10.46747/cfp.6807e204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the acceptability of providing free access to only a short list of medicines used in the Carefully seLected and Easily Accessible at No charge Medications (CLEAN Meds) trial. DESIGN A multimethod explanatory sequential design including interviews with trial participants and focus groups with prescribers. SETTING Ontario. PARTICIPANTS Participants in the intervention arm of the CLEAN Meds trial and primary care providers who prescribed medicines to those in the intervention arm of the trial. MAIN OUTCOME MEASURES The number of trial participants in each prescription category (ie, prescribed no off-list medicine, prescribed 1 off-list medicine, or prescribed 2 or more off-list medicines) and the acceptability of the list to both participants and prescribers. RESULTS There were 395 participants in the intervention group of the CLEAN Meds trial, but 16 participants withdrew consent or were not prescribed any medicines during the first 12 months of the trial, resulting in a total of 379 participants in the quantitative component of this study. Of the 2648 total prescriptions, 2349 (89%) were for medications that were on or had an equivalent covered by the list. Random sampling was used to select 5 participants to interview from each prescription category. A total of 19 prescribers participated in the focus groups. Themes from participant interviews included the following: having access to medicines on the list was a relief, participants trusted health care professionals to switch medicines and to decide which medicines should be on a publicly funded list, and a short list of essential medicines should be publicly funded. Major themes from the prescribers' focus groups related to the process of developing the list, support for the list, and publicly funding a short list of essential medicines in Canada. CONCLUSION The consensus among trial participants and prescribers is that the short list of medicines used in the trial is comprehensive and provides access to medicines commonly prescribed.
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Affiliation(s)
- Muhamad Z. Ally
- Former research student at MAP Centre for Urban Health Solutions at St Michael's Hospital as part of Unity Health Toronto in Ontario
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Aldabagh A, Abu Farha R, Karout S, Itani R, Abu Hammour K, Alefishat E. Evaluation of Drug Use Pattern in Pediatric Outpatient Clinics in a Tertiary Teaching Hospital Using WHO Drug-Prescribing Indicators. J Multidiscip Healthc 2022; 15:1143-1151. [PMID: 35611000 PMCID: PMC9124472 DOI: 10.2147/jmdh.s362172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose The main aim of the study is to assess physicians’ prescribing patterns using the World Health Organization (WHO) prescribing indicators among pediatric outpatient clinics, and to identify areas in need of intervention regarding the rational use of medicines among pediatric outpatients in Jordan. Methods This is a descriptive observational cross-sectional study that was conducted at the outpatient pediatric clinics at Jordan University Hospital (JUH). During the study period, prescriptions were collected over a period of two months. Prescribing patterns were assessed using the five WHO drug prescribing indicators. Results A total of 1011 prescriptions/encounters were assessed. More than half of the encounters were for male patients (n= 595, 58.9%), and the median age of patients was eight years (IQR = 7.9). The average number of drugs prescribed per encounter was 1.8 ± 1.3; however, a specific individual clinic, the respiratory clinic, witnessed an average of 2.1 drugs prescribed per encounter. All of the prescribed drugs were prescribed by generic name (100%). Only 47.7% of the drugs were from the essential drug list of the JUH. Overall, antibiotics were prescribed in 19.5% of the encounters, but at higher rates in some clinics such as respiratory clinics (50.8%). Injectables were prescribed in 9.5% of the 1011 encounters; however, they were prescribed at higher rates in endocrinology and neurology clinics, in 44.8% and 31.3% of encounters, respectively. Conclusion This study revealed some adequate prescribing habits with an optimal prescribing pattern of generics and number of drugs per encounter among pediatric patients. However, the prescribing patterns of the essential drug list, antibiotics, and injectables, in specific clinics, failed to meet WHO standards. The findings of this study shed light on the need to establish national strategies to improve prescribing practices among the pediatric population.
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Affiliation(s)
- Aya Aldabagh
- Department Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rana Abu Farha
- Department Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Samar Karout
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Rania Itani
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Khawla Abu Hammour
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
| | - Eman Alefishat
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Correspondence: Eman Alefishat, Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, P O Box 127788, Abu Dhabi, United Arab Emirates, Tel +9715018466, Email
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Persaud N, Bedard M, Boozary A, Glazier RH, Gomes T, Hwang SW, Juni P, Law MR, Mamdani M, Manns B, Martin D, Morgan SG, Oh P, Pinto AD, Shah BR, Sullivan F, Umali N, Thorpe KE, Tu K, Laupacis A. Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial. PLoS Med 2021; 18:e1003590. [PMID: 34019540 PMCID: PMC8139488 DOI: 10.1371/journal.pmed.1003590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence to medicines is low for a variety of reasons, including the cost borne by patients. Some jurisdictions publicly fund medicines for the general population, but many jurisdictions do not, and such policies are contentious. To our knowledge, no trials studying free access to a wide range of medicines have been conducted. METHODS AND FINDINGS We randomly assigned 786 primary care patients who reported not taking medicines due to cost between June 1, 2016 and April 28, 2017 to either free distribution of essential medicines (n = 395) or to usual medicine access (n = 391). The trial was conducted in Ontario, Canada, where hospital care and physician services are publicly funded for the general population but medicines are not. The trial population was mostly female (56%), younger than 65 years (83%), white (66%), and had a low income from wages as the primary source (56%). The primary outcome was medicine adherence after 2 years. Secondary outcomes included control of diabetes, blood pressure, and low-density lipoprotein (LDL) cholesterol in patients taking relevant treatments and healthcare costs over 2 years. Adherence to all appropriate prescribed medicines was 38.7% in the free distribution group and 28.6% in the usual access group after 2 years (absolute difference 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004). There were no statistically significant differences in control of diabetes (hemoglobin A1c 0.27; 95% CI -0.25 to 0.79, p = 0.302), systolic blood pressure (-3.9; 95% CI -9.9 to 2.2, p = 0.210), or LDL cholesterol (0.26; 95% CI -0.08 to 0.60, p = 0.130) based on available data. Total healthcare costs over 2 years were lower with free distribution (difference in median CAN$1,117; 95% CI CAN$445 to CAN$1,778, p = 0.006). In the free distribution group, 51 participants experienced a serious adverse event, while 68 participants in the usual access group experienced a serious adverse event (p = 0.091). Participants were not blinded, and some outcomes depended on participant reports. CONCLUSIONS In this study, we observed that free distribution of essential medicines to patients with cost-related nonadherence substantially increased adherence, did not affect surrogate health outcomes, and reduced total healthcare costs over 2 years. TRIAL REGISTRATION ClinicalTrials.gov NCT02744963.
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Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bedard
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew Boozary
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Richard H Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Juni
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training at St Michael's Hospital and Vector Institute, Toronto, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Oh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Division of Population and Behavioral Science, University of St Andrews, Scotland
| | - Norman Umali
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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McLaughlin T, Jong G', Gilpin A, Hepburn CM. Pharmacare in Canada: The paediatric perspective. Paediatr Child Health 2020; 25:113-124. [PMID: 32189975 DOI: 10.1093/pch/pxz176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/20/2019] [Indexed: 11/13/2022] Open
Abstract
Canada's drug insurance system is one of the most expensive in the world, yet millions of Canadians still struggle to access necessary medications. As a result, provincial, territorial, and federal governments are considering public pharmacare policy proposals to ensure that all Canadians can access the medications they need. Pharmacare policies offer an opportunity to prioritize children and youth, whose unique drug needs have long been neglected. Prescription drug use is common in this population, with approximately half of Canadian children and youth requiring at least one prescription in any given year. Drug use remains concentrated, however, among those with complex, chronic, and serious diseases. Children and youth rely heavily on compounded and off-label prescription drugs, which impacts safety, efficacy, palatability, and cost. Reimbursement decision-making bodies do not appropriately value the unique benefits of paediatric drugs, including child-friendly formulations, improved quality of life for children and families, and cost-savings outside the healthcare system. Regardless of the pharmacare model ultimately implemented, ensuring universal, comprehensive, and portable prescription drug coverage for all children and youth is essential. To accomplish this, paediatric drug experts should develop a national, evidence-informed formulary of paediatric drugs. Health Canada should also improve processes to make commercial paediatric drugs and child-friendly formulations more available and accessible. The federal government must also support paediatric drug research and development to this end.
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Affiliation(s)
| | | | - Andrea Gilpin
- Goodman Family Pediatric Formulations Centre, CHU Sainte-Justine, Montreal, Quebec
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McLaughlin T, Jong G‘, Gilpin A, Hepburn CM. L’assurance médicaments au Canada : le point de vue de la pédiatrie. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxz177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Résumé
Le système d’assurance médicaments du Canada est l’un des plus coûteux au monde, mais des millions de Canadiens peinent pourtant à accéder aux médicaments dont ils ont besoin. C’est pourquoi les gouvernements fédéral, provinciaux et territoriaux envisagent des propositions de polices d’assurance médicaments publiques pour tous les Canadiens. Les polices d’assurance médicaments permettent de prioriser les enfants et les adolescents, dont les besoins pharmacologiques particuliers ont longtemps été négligés. La prise de médicaments sur ordonnance est courante au sein de cette population, puisqu’environ la moitié des enfants et des adolescents canadiens ont besoin d’au moins une ordonnance au cours d’une année donnée. La prise de médicaments demeure toutefois concentrée au sein des populations atteintes de maladies complexes, chroniques ou graves. Les enfants et les adolescents recourent largement aux préparations magistrales et aux médicaments dans un emploi non conforme à l’étiquette, ce qui a une incidence sur l’innocuité, l’efficacité, la palatabilité et les coûts. Les organes décisionnels en matière de remboursement n’accordent pas toute l’importance qu’ils devraient aux avantages uniques des médicaments pédiatriques, ce qui inclut les formulations adaptées à la pédiatrie, une meilleure qualité de vie pour les enfants et les familles et les économies à l’extérieur du système de santé. Quel que soit le modèle d’assurance médicaments finalement adopté, il est essentiel d’offrir une couverture d’assurance médicaments sur ordonnance complète, universelle et transférable pour tous les enfants et les adolescents. C’est pourquoi les experts des médicaments pédiatriques doivent créer un formulaire national de médicaments pédiatriques fondé sur des données probantes. Santé Canada doit également améliorer les processus pour que les formulations et médicaments commerciaux adaptés à la pédiatrie deviennent plus disponibles et accessibles. À cette fin, le gouvernement fédéral doit également soutenir la recherche-développement des médicaments pédiatriques.
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Affiliation(s)
| | | | - Andrea Gilpin
- Le Centre de formulations pédiatriques de la famille Rosalind et Morris Goodman du CHU Sainte-Justine, Montréal (Québec)
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Morgan SG, Daw JR, Greyson D, Shnier A, Holbrook A, Lexchin J. Variation in the prescription drugs covered by health systems across high-income countries: A review of and recommendations for the academic literature. Health Policy 2020; 124:231-238. [PMID: 31926652 DOI: 10.1016/j.healthpol.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because not all medicines are equally safe, effective, and affordable, health systems often use formularies to define explicitly which medicines will be included and excluded from coverage. OBJECTIVE We sought to synthesize methods and findings from published studies of formulary variation across health systems in high-income countries. METHODS We conducted a systematic review of peer-reviewed research papers published from 2000 to 2017, inclusively. Because of the heterogeneous nature of the literature, we used an inductive approach to summarize methods and findings. RESULTS Nine studies met our study inclusion criteria. Included studies used a variety of methods for selecting medicines for analysis, for measuring coverage levels, and for measuring concordance between formularies. Studies assessing variations in coverage of all licensed medicines and found lower rates of cross-national coverage variation than studies of coverage for selected specialty drugs and indications. The one study that focused on coverage of high-volume medicines found the most complete and consistent levels of formulary listings across countries. CONCLUSION Although published studies contain interesting findings that likely have prompted discussions about their policy implications, the literature can be improved with greater transparency concerning the overarching objective of work in this area and more rigor concerning the selection, analysis, and reporting of data.
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, #267 - 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Jamie R Daw
- Mailman School of Public Health, Columbia University, United States
| | - Devon Greyson
- Department of Communication, University of Massachusetts, Amherst, United States
| | - Adrienne Shnier
- School of Health Policy & Management, York University, Canada
| | - Anne Holbrook
- Division of Clinical Pharmacology & Toxicology, McMaster University, Canada
| | - Joel Lexchin
- School of Population and Public Health, University of British Columbia, #267 - 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Persaud N, Bedard M, Boozary AS, Glazier RH, Gomes T, Hwang SW, Jüni P, Law MR, Mamdani MM, Manns BJ, Martin D, Morgan SG, Oh PI, Pinto AD, Shah BR, Sullivan F, Umali N, Thorpe KE, Tu K, Laupacis A. Effect on Treatment Adherence of Distributing Essential Medicines at No Charge: The CLEAN Meds Randomized Clinical Trial. JAMA Intern Med 2020; 180:27-34. [PMID: 31589276 PMCID: PMC6784757 DOI: 10.1001/jamainternmed.2019.4472] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/12/2019] [Indexed: 11/14/2022]
Abstract
Importance Nonadherence to treatment with medicines is common globally, even for life-saving treatments. Cost is one important barrier to access, and only some jurisdictions provide medicines at no charge to patients. Objective To determine whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improves adherence. Design, Setting, and Participants A multicenter, unblinded, parallel, 2-group, superiority, outcomes assessor-blinded, individually randomized clinical trial conducted at 9 primary care sites in Ontario, Canada, enrolled 786 patients between June 1, 2016, and April 28, 2017, who reported cost-related nonadherence. Follow-up occurred at 12 months. The primary analysis was performed using an intention-to-treat principle. Interventions Patients were randomly allocated to receive free medicines on a list of essential medicines in addition to otherwise usual care (n = 395) or usual medicine access and usual care (n = 391). Main Outcomes and Measures The primary outcome was adherence to treatment with all medicines that were appropriately prescribed for 1 year. Secondary outcomes were hemoglobin A1c level, blood pressure, and low-density lipoprotein cholesterol levels 1 year after randomization in participants taking corresponding medicines. Results Among the 786 participants analyzed (439 women and 347 men; mean [SD] age, 51.7 [14.3] years), 764 completed the trial. Adherence to treatment with all medicines was higher in those randomized to receive free distribution (151 of 395 [38.2%]) compared with usual access (104 of 391 [26.6%]; difference, 11.6%; 95% CI, 4.9%-18.4%). Control of type 1 and 2 diabetes was not significantly improved by free distribution (hemoglobin A1c, -0.38%; 95% CI, -0.76% to 0.00%), systolic blood pressure was reduced (-7.2 mm Hg; 95% CI, -11.7 to -2.8 mm Hg), and low-density lipoprotein cholesterol levels were not affected (-2.3 mg/dL; 95% CI, -14.7 to 10.0 mg/dL). Conclusions and Relevance The distribution of essential medicines at no charge for 1 year increased adherence to treatment with medicines and improved some, but not other, disease-specific surrogate health outcomes. These findings could help inform changes to medicine access policies such as publicly funding essential medicines. Trial Registration ClinicalTrials.gov identifier: NCT02744963.
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Affiliation(s)
- Navindra Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael Bedard
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew S. Boozary
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
| | - Richard H. Glazier
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Jüni
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael R. Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad M. Mamdani
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Steven G. Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul I. Oh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew D. Pinto
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Upstream Lab, MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Baiju R. Shah
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Frank Sullivan
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Division of Population and Behavioral Science, University of St Andrews, St Andrews, Scotland
| | - Norman Umali
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Applied Health Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Jarvis JD, Murphy A, Perel P, Persaud N. Acceptability and feasibility of a national essential medicines list in Canada: a qualitative study of perceptions of decision-makers and policy stakeholders. CMAJ 2019; 191:E1093-E1099. [PMID: 31591095 PMCID: PMC6779536 DOI: 10.1503/cmaj.190567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Policy approaches have been considered to address inconsistent and inequitable prescription drug coverage in Canada, including a national essential medicines list. We sought to explore key factors influencing the acceptability and feasibility of an essential medicines list in Canada. METHODS: We conducted semi-structured interviews with decision-makers and other key stakeholders from government or pan-Canadian institutions, civil society and the private sector across Canada. We analyzed data using inductive thematic analysis and by applying Kingdon’s Multiple Streams Framework to analyze the emergent themes deductively. RESULTS: We conducted 21 interviews before thematic saturation was achieved. We categorized emergent themes to describe the problem, the essential medicines list policy (including content and process), and politics. There was consensus among participants that prescription drug coverage was an important problem to address. Participants differed in their views on how to define essential medicines and concerns about what would be excluded from an essential medicines list. There was consensus on important features for a process to develop an essential medicines list: an independent decision-making body, use of defined selection criteria based on quality evidence, and clear communication of the purpose of the essential medicines list. Federal government financing and the broader pharmacare model, engagement of various interest groups and changing political agendas emerged as core political factors to consider if developing a Canadian essential medicines list. INTERPRETATION: Although stakeholders’ views on the content of a Canadian essential medicines list varied, there was consensus on the process to formulate and implement an essential medicines list or common national formulary, including choosing medicines based on best evidence. Greater understanding is now needed on how patients, clinicians and the public perceive the concept of an essential medicines list.
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Affiliation(s)
- Jordan D Jarvis
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont.
| | - Adrianna Murphy
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
| | - Pablo Perel
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
| | - Nav Persaud
- London School of Hygiene & Tropical Medicine (Jarvis), London, UK; Centre for Urban Health Solution (Jarvis), St. Michael's Hospital, Toronto, Ont.; Department of Health Services Research and Policy (Murphy); Epidemiology and Population Health Faculty (Perel), London School of Hygiene & Tropical Medicine, London, UK; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
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Bissell K, Ellwood P, Ellwood E, Chiang CY, Marks GB, El Sony A, Asher I, Billo N, Perrin C. Essential Medicines at the National Level: The Global Asthma Network's Essential Asthma Medicines Survey 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E605. [PMID: 30791442 PMCID: PMC6406388 DOI: 10.3390/ijerph16040605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022]
Abstract
Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013⁻2020 sets an 80% target for essential NCD medicines' availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013⁻2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses-41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system's capacity to address NCDs.
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Affiliation(s)
- Karen Bissell
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Chen-Yuan Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney 2085, Australia.
| | - Asma El Sony
- The Epidemiological Laboratory (Epi-Lab), for Public Health and Research, Khartoum, Sudan.
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Nils Billo
- Independent Consultant, 80220 Joensuu, Finland.
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Woods H, Oronsaye E, Bali A, Rajakulasingam Y, Lee T, Umali N, Cohen E, Finkelstein Y, Offringa M, Persaud N. Development of a provisional essential medicines list for children in Canada: consensus process. CMAJ Open 2018; 6:E146-E150. [PMID: 29592851 PMCID: PMC5878944 DOI: 10.9778/cmajo.20170129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Worldwide, many countries have developed a list of essential medicines for children to improve prescribing. We aimed to create an essential medicines list for children in Canada. METHODS We adapted the previously created preliminary list of essential medicines for adults in Canada and the WHO Model List of Essential Medicines for Children to create a provisional list of essential medicines for children in Canada. Canadian clinicians made suggestions for changes. Literature relevant to each suggestion was presented to clinician-scientists, who used a modified nominal group technique to make recommendations on the suggestions. Ontario Public Drug Programs prescription data were reviewed to identify commonly prescribed medications missing from the list. Literature relevant to these medications was shared with a clinician-scientist review panel to determine which should be added, and a revised list was developed. RESULTS A total of 76 items were removed from the list of essential medicines for adults in Canada because they were not indicated for use in children or were not relevant in the Canadian health care context; 7 medications were added to the child list based on Ontario Public Drugs Programs prescribing data and clinician-scientist review. Suggestions to add, remove or substitute medications were made by peer-reviewers and resulted in removal of 1 medication and replacement of 1 medication. The process produced a provisional list of 67 essential medications for children. INTERPRETATION A provisional list of 67 essential medicines for children was created through a peer-reviewed, multistep process based on current clinical evidence, Canadian clinical practice guidelines and historical prescribing data. It is publicly posted at http://cleanmeds.ca/. The list should be further developed based on wider input and should be continuously revised based on emerging evidence of the safety and effectiveness of these medicines in all pediatric age groups.
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Affiliation(s)
- Hannah Woods
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Efosa Oronsaye
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Anjli Bali
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Yathavan Rajakulasingam
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Taehoon Lee
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Norman Umali
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Eyal Cohen
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Yaron Finkelstein
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Martin Offringa
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
| | - Nav Persaud
- Affiliations: Centre for Urban Health Solutions (Woods, Oronsaye, Bali, Rajakulasingam, Lee, Umali, Persaud), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Persaud), University of Toronto; The Hospital for Sick Children (Cohen, Finkelstein, Offringa); University of Toronto (Cohen, Finkelstein, Offringa); Institute of Health Policy, Management and Evaluation (Cohen, Persaud), Toronto, Ont
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Persaud N, Lee T, Ahmad H, Li W, Taglione MS, Rajakulasingam Y, Umali N, Boozary A, Glazier RH, Gomes T, Hwang SW, Jüni P, Law M, Mamdani MM, Manns B, Martin D, Morgan S, Oh P, Pinto AD, Shah BR, Sullivan FM, Thorpe KE, Tu K, Laupacis A. Protocol for a randomised controlled trial evaluating the effects of providing essential medicines at no charge: the Carefully seLected and Easily Accessible at No Charge Medicines (CLEAN Meds) trial. BMJ Open 2017; 7:e015686. [PMID: 28611089 PMCID: PMC5623428 DOI: 10.1136/bmjopen-2016-015686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cost-related non-adherence to medicines is common in low-income, middle-income and high-income countries such as Canada. Medicine non-adherence is associated with poor health outcomes and increased mortality. This randomised trial will test the impact of a carefully selected list of essential medicines at no charge (compared with usual medicine access) in primary care patients reporting cost-related non-adherence. METHODS AND ANALYSIS This is an open-label, parallel two-arm, superiority, individually randomised controlled trial conducted in three primary care sites (one urban, two rural) in Ontario, Canada, that was codesigned by a community guidance panel. Adult patients (≥18 years) who report cost-related non-adherence to medicines are eligible to participate in the study. Participants will be randomised to receive free and convenient access to a carefully selected list of 125 essential medicines (based on the WHO's Model List of Essential Medicines) or usual means of medicine access. Care for patients in both groups will otherwise be unchanged. The primary outcome of this trial is adherence to appropriately prescribed medicines. Secondary outcomes include medicine adherence, appropriate prescribing, blood pressure, haemoglobin A1c, low-density lipoprotein cholesterol, patient-oriented outcomes and healthcare costs. All participants will be followed for at least 12 months. ETHICS AND DISSEMINATION Ethics approval was obtained in all three participating sites. Results of the main trial and secondary outcomes will be submitted for publication in a peer-reviewed journal and discussed with members of the public and decision makers. TRIAL REGISTRATION NUMBER NCT02744963.
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Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Taehoon Lee
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Haroon Ahmad
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Winny Li
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | | | | | - Norman Umali
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew Boozary
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States
| | - Richard H Glazier
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Tara Gomes
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Stephen W Hwang
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Peter Jüni
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad M Mamdani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Centre for Healthcare Analytics Research and Training, St Michael’s Hospital, Toronto, Canada
| | - Braden Manns
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Interdisciplinary Chronic Disease Collaboration, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Danielle Martin
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Canada
| | - Steve Morgan
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Andrew David Pinto
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Frank M Sullivan
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Canada
| | - Kevin E Thorpe
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Central Primary Care and Population Health Research Program, Institute for Clinical Evaluative Sciences, Toronto, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Canada
| | - Andreas Laupacis
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
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14
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Morgan SG, Li W, Yau B, Persaud N. Estimated effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada. CMAJ 2017; 189:E295-E302. [PMID: 28246223 DOI: 10.1503/cmaj.161082] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Canada's universal health care system does not include universal coverage of prescription drugs. We sought to estimate the effects of adding universal public coverage of an essential medicines list to existing public drug plans in Canada. METHODS We used administrative and market research data to estimate the 2015 shares of the volume and cost of prescriptions filled in the community setting that were for 117 drugs on a model list of essential medicines for Canada. We compared prices of these essential medicines in Canada with prices in the United States, Sweden and New Zealand. We estimated the cost of adding universal public drug coverage of these essential medicines based on anticipated effects on medication use and pricing. RESULTS The 117 essential medicines on the model list accounted for 44% of all prescriptions and 30% of total prescription drug expenditures in 2015. Average prices of generic essential medicines were 47% lower in the US, 60% lower in Sweden and 84% lower in New Zealand; brand-name drugs were priced 43% lower in the US. Estimated savings from universal public coverage of these essential medicines was $4.27 billion per year (range $2.72 billion to $5.83 billion; 28% reduction) for patients and private drug plan sponsors, at an incremental government cost of $1.23 billion per year (range $373 million to $1.98 billion; 11% reduction). INTERPRETATION Our analysis showed that adding universal public coverage of essential medicines to the existing public drug plans in Canada could address most of Canadians' pharmaceutical needs and save billions of dollars annually. Doing so may be a pragmatic step forward while more comprehensive pharmacare reforms are planned.
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Medicine (Li), University of Toronto, Toronto, Ont.; Faculty of Medicine (Yau), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont.
| | - Winny Li
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Medicine (Li), University of Toronto, Toronto, Ont.; Faculty of Medicine (Yau), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
| | - Brandon Yau
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Medicine (Li), University of Toronto, Toronto, Ont.; Faculty of Medicine (Yau), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
| | - Nav Persaud
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; Faculty of Medicine (Li), University of Toronto, Toronto, Ont.; Faculty of Medicine (Yau), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Persaud), University of Toronto, Toronto, Ont
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