Access to medicines: cost as an influence on the views and behaviour of patients

Abstract

The present paper explores how charges for medicines incurred by patients influence their decisions for managing acute or chronic conditions, and whether prescription cost and affordability issues are discussed in the general practitioner (GP)-patient encounter. People suffering from dyspepsia, hay fever or hypertension, or those taking hormone replacement therapy, were recruited through three community pharmacies in the North-west of England. Six focus groups were conducted with a total of 31 participants, the majority of whom were non-exempt from prescription charges. The management behaviour of those participants who had to pay for their prescriptions, particularly those from less-affluent or deprived backgrounds, was influenced by cost. However, cost was not the overriding influence, with other factors, such as symptom or disease severity, effectiveness, or necessity of treatment, playing a more important part in participants' management decisions. Cost as an issue was reflected in the various strategies used by participants to reduce medication cost, such as not having some prescribed items dispensed, taking a smaller dose or buying a cheaper over-the-counter product. Despite the use of numerous strategies, participants did not talk to their GPs about issues of cost and affordability. Participants felt that paying for prescriptions was their problem. There was a belief that discussing cost issues could jeopardise the doctor-patient relationship. Although not the dominant factor, medication cost nevertheless influenced participants when deciding how to manage their condition. Awareness of the existence of prepayment certificates, which can be bought by patients who require regular medication, was low, and this should be addressed through improved information/dissemination. Despite the high level of prescription items exempt, the current level of the prescription charge is still a barrier to obtaining prescription medicines under the National Health Service to those on lower incomes.

Understanding Frequent Emergency Room Use by Medicaid-Insured Children with Asthma: A Combined Quantitative and Qualitative Study

“…They have been used extensively to identify issues in low-income populations and groups with low literacy levels where conventional survey techniques are inappropriate and ineffective. [17][18][19] The mothers in our focus group used ER services primarily because they perceived that primary care practices were not organized to meet the needs of their children with asthma. Besides difficulties in obtaining urgent advice or appointments, they frequently had difficulties in transport, childcare, or work release that impeded using the primary care office as the principal site of asthma care.…”

Prevalence of Hypertension among Urban Slum Dwellers in Lagos, Nigeria

“…Strategies for improving access to drugs such as sustainable community health financing and provision of affordable medications will influence patient adherence positively. 29 Non-adherence to treatment will ultimately lead to the development of long term complications of the disease, place more economic burden on the slum dwellers that are already disadvantaged economically. It is therefore imperative for the government to provide health care services which is available, accessible and affordable to all categories of people according to the principles of primary health care irrespective of their social strata in the society.…”

Strategies for Coping in a Complex World: Adherence Behavior Among Older Adults with Chronic Illness

“…Increased numbers of medicines increase nonadherence 13,14 because of increased complexity [15][16][17][18][19][20] or cost. 12,[21][22][23][24] Increased age is not associated independently with reduced adherence. 13,25 Chronic conditions are associated with continually changing symptoms, severity, stigma and future risk, all of which affect adherence to health-promoting behaviors, including medicines.…”