Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial

Abstract

Background Adherence to medicines is low for a variety of reasons, including the cost borne by patients. Some jurisdictions publicly fund medicines for the general population, but many jurisdictions do not, and such policies are contentious. To our knowledge, no trials studying free access to a wide range of medicines have been conducted. Methods and findings We randomly assigned 786 primary care patients who reported not taking medicines due to cost between June 1, 2016 and April 28, 2017 to either free distribution of essential medicines (n = 395) or to usual medicine access (n = 391). The trial was conducted in Ontario, Canada, where hospital care and physician services are publicly funded for the general population but medicines are not. The trial population was mostly female (56%), younger than 65 years (83%), white (66%), and had a low income from wages as the primary source (56%). The primary outcome was medicine adherence after 2 years. Secondary outcomes included control of diabetes, blood pressure, and low-density lipoprotein (LDL) cholesterol in patients taking relevant treatments and healthcare costs over 2 years. Adherence to all appropriate prescribed medicines was 38.7% in the free distribution group and 28.6% in the usual access group after 2 years (absolute difference 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004). There were no statistically significant differences in control of diabetes (hemoglobin A1c 0.27; 95% CI −0.25 to 0.79, p = 0.302), systolic blood pressure (−3.9; 95% CI −9.9 to 2.2, p = 0.210), or LDL cholesterol (0.26; 95% CI −0.08 to 0.60, p = 0.130) based on available data. Total healthcare costs over 2 years were lower with free distribution (difference in median CAN$1,117; 95% CI CAN$445 to CAN$1,778, p = 0.006). In the free distribution group, 51 participants experienced a serious adverse event, while 68 participants in the usual access group experienced a serious adverse event (p = 0.091). Participants were not blinded, and some outcomes depended on participant reports. Conclusions In this study, we observed that free distribution of essential medicines to patients with cost-related nonadherence substantially increased adherence, did not affect surrogate health outcomes, and reduced total healthcare costs over 2 years. Trial registration ClinicalTrials.gov NCT02744963.

Prescription audit of a teaching hospital in South India using World Health Organization core prescribing indicators – A cross-sectional study

“…[ 6 ] Further choice of medicine, based on adequate data on safety, efficacy, and cost-effectiveness, from the National List Of Essential Medicines (NLEM) improves the patient compliance. [ 7 ] Most of the studies indicate the prescribing pattern of primary and secondary level government hospitals, and there is a gap in the data of drug usage pattern among private tertiary level teaching hospitals in India. In this study, we aim to assess the prescription pattern and prescribing behavior of physicians at a teaching hospital in South India using the WHO-recommended core prescribing indicators.…”

Evaluation of Hospital-Based Acute Care Utilization by Uninsured Patients Enrolled in Free or Low-Cost Pharmacy Programs

“… 31 Another randomized trial found a decrease in blood pressure and increase in medication adherence following provision of free medications. 32 Supplying free medications to patients without private insurance after myocardial infarction showed an increase in quality-adjusted survival and cost-effectiveness in a third study. 33 …”

Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study

“…Among solutions, fixed drug combinations have been shown to enhance adherence and effectiveness of treatment by combining different treatments with different mechanisms of action. Randomised controlled trial on adherence to treatment by providing fixed drug combination free of charge in other part of the world achieve to increase BP control 25. However, fixed drug combinations are poorly available and affordable in low and middle-income countries.…”