Acceptability of a short list of essential medicines to patients and prescribers

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 measuresThe 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. ConclusionThe 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.This article has been peer reviewed. Cet article a fait l'objet d'une révision par des pairs.

Effect of Free Medicine Distribution on Health Care Costs in Canada Over 3 Years

“…These findings suggest that it may take time for adherence to improve health, and preventive medicines might be relatively more beneficial among unselected outpatients than among recently hospitalized patients. The current findings suggest that promoting health equity by improving medicine access can reduce overall health care costs, thereby adding to prior studies showing that free medicine distribution improves the experiences of patients and clinicians . Thus, free medicine distribution may help achieve the quintuple aim that includes both reducing health care spending and improving health equity or fairness in health care and outcomes by ensuring that financial means are not a barrier to realizing the benefits of medicines .…”

“…The current findings suggest that promoting health equity by improving medicine access can reduce overall health care costs, thereby adding to prior studies showing that free medicine distribution improves the experiences of patients and clinicians. 12 , 13 Thus, free medicine distribution may help achieve the quintuple aim that includes both reducing health care spending and improving health equity or fairness in health care and outcomes by ensuring that financial means are not a barrier to realizing the benefits of medicines. 4 The present findings support a recent call for pharmacoequity, or access to high-quality medicines, “regardless of race and ethnicity, socioeconomic status, or availability of resources” 14 (p1793) by demonstrating economic benefits of fair access.…”

Of curing and healing

“…Ally et al (page e204) address access to a comprehensive selection of essential and effective medications for all Canadians. 5 This mixed-methods study builds on the CLEAN Meds randomized controlled trial that investigated the effects on patient adherence of free and convenient access to essential medicines. 6 The current study shows consensus among participants and prescribers that the short list of medicines used in the trial is comprehensive and provides access to commonly prescribed medicines.…”

“…6 The current study shows consensus among participants and prescribers that the short list of medicines used in the trial is comprehensive and provides access to commonly prescribed medicines. 5 But, as our predecessors understood, it can take more than medications to help us heal. A visit to one of my patients in hospital provided a stark reminder.…”