scholarly journals Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level

2021 ◽  
Vol 96 (1) ◽  
Author(s):  
Hoda Ibrahim Rizk ◽  
Monira Mahmoud Elkholy ◽  
Abeer Abdou Barakat ◽  
Raghda Mostafa Mostafa Elsayed ◽  
Shaimaa A. M. Abd El Fatah
Keyword(s):  
Health System ◽  
Access To Medicines ◽  
Generic Medicine ◽  
Essential Medicines ◽  
Cross Sectional ◽  
Urban Group ◽  
Rural And Urban ◽  
External Stakeholders ◽  
Assessment Approach ◽  
The Government

Abstract Background Equitable access to essential medicines of maintained efficacy, safety, quality, and cost-effectiveness must be ensured by a well-functioning health system. This study aims to identify the determinants of patients’ access to medicines at the primary health care (PHC) level from the perspectives of various (internal and external) stakeholders of the pharmaceutical system. Methods The study employed both quantitative and qualitative components. Quantitative component applied a descriptive a cross-sectional design and qualitative component applied an in-depth interview design. It was a health system research conducted at two (PHC) facilities (one urban and the other rural) in Egypt. It inquired upon political, economic, and managerial aspects of the pharmaceutical system utilizing the “Health System Assessment Approach: a How-To Manual” and the “WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations.” Results Analysis of the quantitative data extracted from the cross-sectional component with external stakeholders (patients) revealed that about one-third of patients in both facilities were unable to pay for the medicine. Patients in both settings took less than an hour to reach the PHC facility. The Percent of patients who believe that the private pharmacies’ medicine is better than the PHC one was significantly higher in rural than urban group (24% and 10% respectively) and the percent of medicines dispensed was 50% and 66.7% in rural and urban groups respectively. Analysis of the qualitative data extracted from in-depth interviews with internal stakeholders (key informants from regulatory agencies, pharmaceutical industry, academia, pharmacists, and physicians) were summarized utilizing Strengths-Weaknesses-Opportunities-Challenges (SWOC) analysis approach. Various viewpoints toward the determinants of patients’ access to medicines were disclosed. Conclusions The Percent of medicines dispensed was insufficient in both rural and urban facilities. There is a need to invest in building trust in generic medicine quality in the government health facilities focusing on improving medicine availability and ensuring enough amounts of high-quality drugs. Although there are drug committees in the two studied PHC facilities for demonstrating the prescribing and dispensing policies, yet the system required to enforce these policies is still deficient.

scholarly journals Access to medicines by patients of the primary health care in the Brazilian Unified Health System

2017 ◽  
Vol 51 ◽  
pp. 20s ◽  
Author(s):  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Vânia Eloisa de Araújo ◽  
Alessandra Maciel Almeida ◽  
Carolina Zampirolli Dias ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Developed Countries ◽  
Access To Medicines ◽  
Essential Medicines ◽  
Unified Health System ◽  
Primary Health ◽  
Significant Difference ◽  
Good For

OBJECTIVE: To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS: This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS: For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS: Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population

scholarly journals Knowledge, attitude and practices regarding generic medicines and its usage: a community-based study

2019 ◽  
Vol 6 (5) ◽  
pp. 2182 ◽  
Author(s):  
Kirthinath Ballala ◽  
Chythra R. Rao ◽  
Aparna S. Chaudhary ◽  
Ashwini S. Bidnurmath ◽  
Akhilesh K. Pandey
Keyword(s):  
Urban Areas ◽  
Generic Drugs ◽  
Community Outreach ◽  
Essential Medicines ◽  
Generic Medicines ◽  
Online Questionnaire ◽  
Community Based ◽  
Cross Sectional ◽  
Total Study Population ◽  
The Government

Background: India is the largest provider of generic medications globally. Despite this, several essential medicines remain inaccessible to majority of the general population, due to poor awareness, unavailability of drugs, distrust about the quality of the medicines, poor policy implementation and inadequate recommendation by doctors.Methods: A community-based cross-sectional study was carried out among 1151 adults in rural and urban areas attached to the community outreach area of a University Medical College. Written informed consent was taken from the participants. Data was collected using a pre-tested semi-structured online questionnaire and analysed using SPSS 15.0.Results: Knowledge regarding generic medicines was found to be low among the surveyed population (666, 57.9%), irrespective of their socio-economic status, education, occupation, place of residence or presence of chronic illnesses. As the knowledge was poor, participants were briefed about the generic medicines and their benefits. Thereafter, the attitude was assessed and found to be favourable among more than half (633, 55.0%) of the surveyed population. The usage of Generic medicines was found to be poor among the respondents. Only 53 (4.6%) of the total study population had switched from branded to generic medicines in the past six months as generic medicines were less expensive compared to their branded counterparts.Conclusions: The awareness about generic drugs and its usage was poor in the surveyed population. A favourable attitude towards generic drugs was achieved by educating the people about their similarity to branded medications. Therefore, there is a need to educate people not only about the quality, safety and efficacy of the generic medicines but also about the government initiatives like the Jan Aushadhi scheme. 

scholarly journals Evaluation of Rational Drug Use based on Indicators of Diseases and Facilities at Community Health Centers in Districts in Semarang

2019 ◽  
Vol 2 (2) ◽  
pp. 119-124
Author(s):  
Nisa Febrinasari ◽  
Abdur Rosyid ◽  
Leny Angelina
Keyword(s):  
Drug Use ◽  
Community Health ◽  
Community Health Centers ◽  
Data Retrieval ◽  
Essential Medicines ◽  
Homogeneity Test ◽  
Cross Sectional ◽  
Rational Drug Use ◽  
Rational Drug ◽  
The Government

Rational drug use (RDU) is an indicator to evaluates a treatment given to patients, like proper medication, precise diagnosis, precise dosing. Community Health Center (CHC) has the risk of irrational drug use. In this study, researchers selected N and BL CHC, aiming to evaluate the prescribing indicators based on three diseases which are non-pneumonia acute respiratory infection (ARI), non-specific diarrhea and myalgia, and the facility indicators with DOEN (list of essential national medicines) availability and 20 mandatory drugs. This research was a descriptive-analytical study with cross-sectional methods where the data retrieval of the prescribing is taken from January to December 2018. The study used the normality test and homogeneity test before independent sample T-test, from the third outcome of the test, the N and BL CHC could be said to differ significantly of RDU. It can be concluded that rational drug use is reviewed from a prescribing indicator based on disease and facility indicator. The results of RDU are rational in N CHC, in contrast with BL CHC which is not rational with the results of the RDU in N CHC is 101.44% and BL CHC is 89.81%. The results of N CHC is better than BL CHC, which both CHCs have fulfilled the target of the government, for 68% in 2018. In both CHCs for the facility indicator, there are a DOEN and 20 essential medicines.

scholarly journals Appropriateness and affordability of prescriptions to diabetic patients attending a tertiary hospital in Eastern Uganda: A retrospective cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245036
Author(s):  
Samuel Baker Obakiro ◽  
Kenedy Kiyimba ◽  
Agnes Napyo ◽  
Andrew Marvin Kanyike ◽  
Wilberforce John Mayoka ◽  
...  
Keyword(s):  
Health Management ◽  
Drug Prescription ◽  
Essential Medicine ◽  
Secondary Data ◽  
Essential Medicines ◽  
Health Management Information System ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
The Government ◽  
Eastern Uganda

Background Irrational prescription of drugs can lead to high cost of treatment thus limiting access to essential medicines. We assessed the affordability and appropriateness of prescriptions written for diabetic patients in Eastern Uganda. Methods We collected secondary data from the health management information system registers of patients who attended the outpatient medical clinic at Mbale regional referral hospital from January 2019 to December 2019. The average cost of the prescriptions was calculated and adjusted odds ratios for predictors for unaffordability estimated using logistic regression. Computed scores for indicators of rational drug prescription were used to assess the extent of rational prescribing. Results The median cost per prescription was USD 11.34 (IQR 8.1, 20.2). Majority of the diabetic patients (n = 2462; 94.3%, 95% CI: 93.3–95.1%) could not afford the prescribed drugs. Predictors for unaffordability were if a prescription contained: ≥ 4 medicines (AOR = 12.45; 95% CI: 3.9–39.7); an injectable (AOR = 5.47; 95%CI: 1.47–20.32) and a diagnosis of diabetes mellitus with other comorbidities (AOR = 3.36; 95%CI: 1.95–5.78). Having no antidiabetic drug prescribed was protective for non-affordability (AOR = 0.38; 95%CI: 0.24–0.61). The average number of drugs per prescription was 2.8. The percentage prescription of drugs by generic name and from the essential medicine and health supplies list of Uganda were (6160/7461; 82.6%, 96% CI: 81.7%-83.4%) and (6092/7461; 81.7%, 95% CI: 80.8%-82.5%) respectively against WHO standard of 100%. Conclusion The majority of diabetic patients (94.3%) in Eastern Uganda cannot afford to buy prescribed medicines. The government should therefore ensure that essential medicines are readily accessible in public health facilities.

scholarly journals Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Caijun Yang ◽  
Shuchen Hu ◽  
Dan Ye ◽  
Minghuan Jiang ◽  
Zaheer-Ud-Din Babar ◽  
...  
Keyword(s):  
Private Sector ◽  
Access To Medicines ◽  
Public Hospitals ◽  
Essential Medicines ◽  
Shaanxi Province ◽  
Price Ratio ◽  
Medicine Price ◽  
Cross Sectional ◽  
The Public ◽  
Health Action

Objectives: To evaluate the price and availability of medicines in China.Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018.Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29–32.87%) and private sectors (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector.Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.

scholarly journals Factors influencing availability of tracer essential medicines in selected health facilities in Nyeri County, Kenya

2021 ◽  
Vol 8 (3) ◽  
pp. 1013
Author(s):  
Minai Samuel Munga ◽  
Tabither Muthoni Gitau ◽  
Lawrence Mirie Kimani ◽  
Peterson Kariuki ◽  
Enoch Ng'etich
Keyword(s):  
Inventory Management ◽  
Health Management ◽  
Policy Formulation ◽  
Emerging Diseases ◽  
Health Facilities ◽  
Essential Medicines ◽  
Supply Chain System ◽  
Cross Sectional ◽  
The Government ◽  
Roll Out

Background: Tracer essential medicines are drugs which fully fulfil a population’s health requirements and ought to be always available allowing for a properly functioning health system all the time. They should be available in the appropriate dosage, adequate amounts and at assured quality at a price that many people and the community can easily afford.Methods: Analytical cross-sectional study design was used. This study utilized a mixed method approach (qualitative, observation and quantitative).Results: The study found out that artemether lumefantrine was the least available drug at 50% in all the sampled facilities with KEMSA cited as the main supplier of tracer essential medicines in these facilities. Policy formulation was done without any involvement of pharmacy in-charges and policies passed at the county management team merely passed onto the staff at the health facilities without their engagement.Conclusions: With the roll out of UHC program, majority of the participants indicated an increase in the availability of essential drugs in Nyeri County hence the government should roll out the program countrywide. Health management and leadership teams in the county needs to engage the pharmacy in-charges during policy making and changes, provide efficient communication in the supply chain system, including proper inventory management systems and to enhance research of drugs and emerging diseases in the county.

scholarly journals A community based cross-sectional study on the health system responsiveness in the urban field practicing area of tertiary health care centre, Hyderabad

2019 ◽  
Vol 6 (2) ◽  
pp. 860
Author(s):  
Jyothi Lakshmi Naga Vemuri ◽  
B. Kiranmai ◽  
Viveka Cheedarla ◽  
S. Bhavana Laxmi
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health System ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
The Mean ◽  
The Government ◽  
Prompt Attention

Background: According to WHO, responsiveness is an important goal of the health system, in addition to the two predominant goals of improving health and fairness of financing. Responsiveness includes non-medical aspects of health care. As the progress to universal health coverage is gaining pace, the present study has attempted to study the domains of responsiveness in the government and private health services and health care providers.Methods: A community based cross-sectional study for a period of 3 months in the households of the urban field practising area. Sampling technique was simple random sampling. Assuming the prevalence of 50% and allowable error of 5%, 400 households were surveyed. KISH table method was used at household level. Study tool was World Health Survey responsiveness module questionnaire for the eight responsiveness domains-prompt attention, dignity, communication, autonomy, confidentiality, choice, quality of basic facilities and social support (for inpatients).Results: The mean age (yrs) of the study subjects is 46.078±13.998. 68.25% (273) were males.31.75% (127) were females. 46.25% (185) were using government services and 53.75% (215) were using private services. The mean waiting time (min) in the public health facilities was 135.2±111.2 which was more than private facilities, 62.4±40.8.Conclusions: All the responsiveness domains (except confidentiality) were found to be positively associated (p<0.05) with the government health services. Proportion of people rating the responsiveness domains from most important to the least important showed prompt attention (52%) and dignity (30%) as the most important domains.

scholarly journals O impacto das fraturas do quadril no SUS 2008 - 2017: O papel do ortopedista

2020 ◽  
Author(s):  
Bernardo Stolnicki ◽  
Bruno Casaes Teixeira
Keyword(s):  
Hip Fracture ◽  
Health System ◽  
Hip Fractures ◽  
Social Impact ◽  
Progressive Increase ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Unified Health System ◽  
The Government ◽  
Ambulatory Rehabilitation

Abstract Objective The present study intends to describe the profile of hospitalization and ambulatory rehabilitation of patients ≥ 50 years old due to hip fracture in the Brazilian Public Health System (SUS, in the Portuguese acronym). Methods This is a cross-sectional study of patients hospitalized due to hip fracture in the SUS between 2008 and 2017. Data included 441,787 hip fracture-related hospitalizations from the hospitalization database of the department of informatics of the Brazilian Unified Health System (SIH/DATASUS, in the Portuguese acronym), and data of patients who underwent rehabilitation from the ambulatory database of the department of informatics of the Brazilian Unified Health System (SIA/DATASUS, in the Portuguese acronym.). Results Most of hip fracture-related hospitalizations (83.5%) happen to people ≥ 50 years old, with an average annual growth of 5.6% in hip fracture-related hospitalizations. The costs for the government have been growing in the same proportion and reached almost BRL 130 million in 2017, although with a 13.6% decrease in average cost per hospitalization. Besides the financial impact, hip fractures result in an in-hospital mortality rate around 5.0% in patients aged ≥ 50 years old. In addition, the percentage of patients that have undergone hip fracture-related rehabilitation increased from 2008 (14.0%) to 2012 (40.0%), and remained stable after that. Conclusions The progressive increase in the incidence of hip fractures shows the financial and social impact, and the need for immediate actions to prevent this rising trend. Hip fractures are a risk for secondary fractures, the prevention is crucial, and the orthopedist plays a central role in this process.

scholarly journals Availability of essential medicines in primary health care of the Brazilian Unified Health System

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Renata Cristina Rezende Macedo do Nascimento ◽  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Isabel Cristina Gomes ◽  
Ediná Alves Costa ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Health Care Professionals ◽  
Congenital Syphilis ◽  
Essential Medicines ◽  
Chi Square ◽  
Cross Sectional ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS). METHODS: This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. RESULTS: One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. CONCLUSIONS: The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer medicines in SUS confirm the general availability verified in this study. Among patients, about 60% said they obtain medicines in SUS units, data consistent with the lack of medicines reported by medicine dispensers and in line with physicians’ evaluations

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