Drug adherence of patients with epilepsy in Iran: the effects of the international economic sanctions

Abstract

Drug adherence of patients with epilepsy was investigated to determine the reasons behind poor adherence. In this retrospective chart review study, all patients with a clinical diagnosis of epilepsy were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences. We routinely asked about the patient's drug adherence and reasons behind poor drug adherence in every office visit. We defined drug adherence adequate if the patient reported less than or equal to one missed dose per month. Patients' drug adherences were investigated during two time periods: March 2010-2011 (before intensification of the international economic sanctions against Iran), and September 2012-2013 (during intensified international economic sanctions). One hundred and ninety-nine patients were studied. Drug adherence was satisfactory in 139 patients (69.8 %) during the first time period. Drug adherence was satisfactory in 146 patients (73.4 %) during the second time period. The most common reasons for poor drug adherence was carelessness, followed by cost and lack of drug availability (1.5 % in the first time period and 4 % in the second time period; P = 0.07). About one-third of patients with epilepsy had poor drug adherence. To overcome the problem, it is important to find the reasons behind poor drug adherence in each patient and try to overcome the cause. Purely from a clinical and patient care perspective, it seems necessary that politicians should facilitate decisions that make the health and well-being of ordinary people more affordable and without hardship.

Time for more evidence: a scoping review of the effects of sanctions on Iranian health

“…Asadi-PooyaAA. [19] A retrograde chart reviewing to investigate the effects of sanctions on drug adherence among patients with epilepsy Reduction in drug adherence was close to being signi cant (P = 0.07) before and after 2012; despite some drugs were unavailable after sanctions, and others were much more expensive. Medicine subsidization by the government seems to play an important role.…”

“…Therefore, ten out of eleven included studies addressed the effects of sanctions on access to medicine in Iran. Three articles studied medicines holistically, [16][17][18] seven articles investigated medications related to some speci c diseases, [19][20][21][22][23][24][25] and the one remaining assessed the effect of sanctions on air pollution. [26] In terms of method, there were 6 quantitative studies, 4 qualitative studies, and one review (Fig.…”

“…2). In order to data collection, studies used media, information obtained from city pharmacies, chart review and question from patients, [19,20,22,25]national reports, [18,23] and literature review. [18,24] The characteristics of included studies are demonstrated in Table 1.…”

“…The health service delivery seems to be impacted in several contexts. Medications being used or treatment of non-communicable diseases, [23] asthma, [28] hemophilia, [22] epilepsy [19,25] and cancers [24,29]became non or less-available in Iran's pharmaceutical market. [18] Also plenty of brief reports highlight impact of sanctions on healthcare and medicine availability in Iran [13,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] Impact of economic sanctions on health service delivery, especially on medication availability reached its highest level in October 2012, when the O ce of Foreign Assets Control (OFAC) of the US Department of the Treasury revised provisions related to Iran's transactions [17].…”

Availability of antiepileptic drugs: Politicians' roles

“…4 However, poor income, lack of resources, regulatory approval, and high prices are apparently not the only factors that play significant roles in lack of access to AEDs and appropriate epilepsy care. In a recent study, 6 we observed that the hardship by the international economic sanctions imposed on the Iranian people in the past few years caused poor access to AEDs in some patients with epilepsy. Compared to the period before the intensification of sanctions, the price of some AEDs (e.g., levetiracetam) increased up to 300% after intensification of the international economic sanctions.…”