Although there was variability regarding the association between complexity and adherence, most studies showed that an increased regimen complexity reduces medication adherence.

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Introduction: Managed Entry Agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high-and middle-income countries. Methods: An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior level co-authors including key South American markets. Afterall, involved senior level decision makers and advisers providing guidance on potential advantages and disadvantages of MEAs and ways forward. Results: 25 studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%), and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. Conclusion: We are likely to see a growth in MEAs with the continual launch of new high priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome based MEAs could be an important tool to improve access to new innovative medicines there are critical issues to address. Comparing knowledge, experiences and practices across countries is crucial to guide high-and middle-income countries when designing their future MEAs.

Aim To systematically review the literature on definitions, tools and factors associated with medication literacy. Methods We searched on Medline, Lilacs, Cochrane, CINAHL, PsycINFO, Embase, Scopus, Web of Science, databases of theses/dissertations and the references of the selected studies. The screening was carried out by two independent researchers. Observational, experimental or methodological studies were eligible for inclusion. The tools were critically analysed and evaluated regarding the dimensions and statements on medication literacy. Results Thirty‐five studies were included. Most were conducted in China and the United States, included adults and were published after 2010. Different terms were identified for literacy in the context of medication use and the most frequently used was “medication literacy”. Its definition varied, but “medication literacy” was generally defined as the individual ability to understand and act on medication‐related information. Twelve tools were identified. Most included only functional and numerical dimensions of literacy. No instrument covered all the essential statements on medication literacy. The tools had essential limitations in their development and measurement characteristics. Factors associated with medication literacy varied among studies, but the most frequent were age, education and inappropriate self‐medication. Conclusion “Medication literacy” is the recommended term for literacy in the context of medication use. Different definitions were identified, and the most comprehensive was the one proposed by Pouliot in 2018. The tools did not cover all the essential literacy skills for medication use and focused only on functional e numeracy domains. Sociodemographic characteristics and inappropriate self‐medication were the most common factors associated with medication literacy.

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