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Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison.

ABSTRACT: Switching or reclassifying medicines with established safety profiles from prescription to non-prescription aims to increase timely consumer access to medicines, reduce under-treatment and enhance self-management. However, risks include suboptimal therapy and adverse effects. With a long-standing government policy supporting switching or reclassifying medicines from prescription to non-prescription, the United Kingdom is believed to lead the world in switch, but evidence for this is inconclusive. Interest in switching medicines for certain long-term conditions has arisen in the United Kingdom, United States, and Europe, but such switches have been contentious. The objective of this study was then to provide a comprehensive comparison of progress in switch for medicines across six developed countries: the United States; the United Kingdom; Australia; Japan; the Netherlands; and New Zealand.A list of prescription-to-non-prescription medicine switches was systematically compiled. Three measures were used to compare switch activity across the countries: "progressive" switches from 2003 to 2013 (indicating incremental consumer benefit over current non-prescription medicines); "first-in-world" switches from 2003 to 2013; and switch date comparisons for selected medicines.New Zealand was the most active in progressive switches from 2003 to 2013, with the United Kingdom and Japan not far behind. The United States, Australia and the Netherlands showed the least activity in this period. Few medicines for long-term conditions were switched, even in the United Kingdom and New Zealand where first-in-world switches were most likely. Switch of certain medicines took considerably longer in some countries than others. For example, a consumer in the United Kingdom could self-medicate with a non-sedating antihistamine 19 years earlier than a consumer in the United States.Proactivity in medicines switching, most notably in New Zealand and the United Kingdom, questions missed opportunities to enhance consumers' self-management in countries such as the United States.

SUBMITTER: Gauld NJ

PROVIDER: S-EPMC4175460 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison.

Gauld Natalie J NJ Kelly Fiona S FS Kurosawa Nahoko N Bryant Linda J M LJ Emmerton Lynne M LM Buetow Stephen A SA

PloS one 20140924 9

<h4>Background</h4>Switching or reclassifying medicines with established safety profiles from prescription to non-prescription aims to increase timely consumer access to medicines, reduce under-treatment and enhance self-management. However, risks include suboptimal therapy and adverse effects. With a long-standing government policy supporting switching or reclassifying medicines from prescription to non-prescription, the United Kingdom is believed to lead the world in switch, but evidence for t ...[more]

PMID: 25251434

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Project description:BACKGROUND: Increasing attention is being paid to the affordability of medicines in low- and middle-income countries (LICs and MICs) where medicines are often highly priced in relation to income levels. The impoverishing effect of medicine purchases can be estimated by determining pre- and postpayment incomes, which are then compared to a poverty line. Here we estimate the impoverishing effects of four medicines in 16 LICs and MICs using the impoverishment method as a metric of affordability. METHODS AND FINDINGS: Affordability was assessed in terms of the proportion of the population being pushed below US$1.25 or US$2 per day poverty levels because of the purchase of medicines. The prices of salbutamol 100 mcg/dose inhaler, glibenclamide 5 mg cap/tab, atenolol 50 mg cap/tab, and amoxicillin 250 mg cap/tab were obtained from facility-based surveys undertaken using a standard measurement methodology. The World Bank's World Development Indicators provided household expenditure data and information on income distributions. In the countries studied, purchasing these medicines would impoverish large portions of the population (up to 86%). Originator brand products were less affordable than the lowest-priced generic equivalents. In the Philippines, for example, originator brand atenolol would push an additional 22% of the population below US$1.25 per day, whereas for the lowest priced generic equivalent this demographic shift is 7%. Given related prevalence figures, substantial numbers of people are affected by the unaffordability of medicines. CONCLUSIONS: Comparing medicine prices to available income in LICs and MICs shows that medicine purchases by individuals in those countries could lead to the impoverishment of large numbers of people. Action is needed to improve medicine affordability, such as promoting the use of quality assured, low-priced generics, and establishing health insurance systems. Please see later in the article for the Editors' Summary.

Project description:BackgroundIn September 2003, the Canadian government committed to developing legislation that would facilitate greater access to affordable medicines for developing countries. Over the course of eight months, the legislation, now known as Canada's Access to Medicines Regime (CAMR), went through a controversial policy development process and the newspaper media was one of the major venues in which the policy debates took place. The purpose of this study was to examine how the media framed CAMR to determine how policy goals were conceptualized, which stakeholder interests controlled the public debate and how these variables related to the public policy process.MethodsWe conducted a qualitative content analysis of newspaper coverage of the CAMR policy and implementation process from 2003-2008. The primary theoretical framework for this study was framing theory. A total of 90 articles from 11 Canadian newspapers were selected for inclusion in our analysis. A team of four researchers coded the articles for themes relating to access to medicines and which stakeholders' voice figured more prominently on each issue. Stakeholders examined included: the research-based industry, the generic industry, civil society, the Canadian government, and developing country representatives.ResultsThe most frequently mentioned themes across all documents were the issues of drug affordability, intellectual property, trade agreements and obligations, and development. Issues such as human rights, pharmaceutical innovation, and economic competitiveness got little media representation. Civil society dominated the media contents, followed far behind by the Canadian government, the research-based and generic pharmaceutical industries. Developing country representatives were hardly represented in the media.ConclusionsMedia framing obscured the discussion of some of the underlying policy goals in this case and failed to highlight issues which are now significant barriers to the use of the legislation. Using the media to engage the public in more in-depth exploration of the policy issues at stake may contribute to a more informed policy development process. The media can be an effective channel for those stakeholders with a weaker voice in policy deliberations to raise public attention to particular issues; however, the political and institutional context must be taken into account as it may outweigh media framing effects.

Project description:BackgroundHistorically our institution has required prospective bariatric patients attend an in-person introductory seminar prior to their first clinic visit. Utilization of the internet has increased dramatically over the last 10 years and in 2016, we added an online seminar. With the emergence of COVID-19 and new rules regarding social distancing, we are currently relying exclusively on web-based orientation. Research suggests there are racial and socioeconomic disparities in the utilization of internet health resources in the general population. To our knowledge this has not been studied in regard to the bariatric population.MethodsA retrospective chart review was performed on patients who attended online (OS) and in-person seminars (IPS). Our primary endpoint was to compare the percentage of patients who underwent surgery. Secondary outcomes included differences in demographic and clinical characteristics between the patients who attended the OS versus the IPS.ResultsOf the 1152 patients who attended a bariatric orientation, 71.2% scheduled an office visit. The IPS patients had a higher rate of office visits and shorter time between orientation and first visit. Of patients eligible for surgery, there was a higher percentage of Caucasians in the OS group while the IPS group had higher rates of Hispanic and African Americans. Patients from the OS group had higher rates of marriage and employment, and lower rates of medical co-morbidities. When controlling for age, sex, race/ethnicity, marital status, employment status and medical co-morbidities, there was no significant impact of type of orientation on progression to surgery.ConclusionWe found that there was no difference in progression to surgery between the two orientation groups. Importantly, however, we detected marked demographic and clinical differences between the two patient populations. There is an urgent need to address these disparities as we are now heavily relying on patient outreach and education via the internet.

Dataset Information

Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison.

Publications

Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison.

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