Appropriateness and affordability of prescriptions to diabetic patients attending a tertiary hospital in Eastern Uganda: A retrospective cross-sectional study

Obakiro, Samuel Baker; Kiyimba, Kenedy; Napyo, Agnes; Kanyike, Andrew Marvin; Mayoka, Wilberforce John; Nnassozi, Aishah Ggalabuzi; Aguti, Beatrice; Akech, Gabriel Madut; Waako, John Paul

doi:10.1371/journal.pone.0245036

Cited by 7 publications

(15 citation statements)

References 23 publications

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“…Out of pocket expenses have been shown to be a significant in impeding access to and retention in NCD care in Africa. A study in eastern Uganda among users with an NCD showed that over 92% of the diabetic users were unable to afford drugs purchases and this increased their rates of multi-morbidity [47]. Other research showed that NCD users in Uganda were found to be unable to afford the cost of care [48] and faced significant geographical constraints to accessing services [49,50].…”

Section: Discussionmentioning

confidence: 99%

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Bukenya

Hout

Shayo

et al. 2022

PLOS Glob Public Health

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Health policies in Africa are shifting towards integrated care services for chronic conditions, but in parts of Africa robust evidence on effectiveness is limited. We assessed the integration of vertical health services for HIV, diabetes and hypertension provided in a feasibility study within five health facilities in Uganda. From November 2018 to January 2020, we conducted a series of three in-depth interviews with 31, 29 and 24 service users attending the integrated clinics within Kampala and Wakiso districts. Ten healthcare workers were interviewed twice during the same period. Interviews were conducted in Luganda, translated into English, and analysed thematically using the concepts of availability, affordability and acceptability. All participants reported shortages of diabetes and hypertension drugs and diagnostic equipment prior to the establishment of the integrated clinics. These shortages were mostly addressed in the integrated clinics through a drugs buffer. Integration did not affect the already good provision of anti-retroviral therapy. The cost of transport reduced because of fewer clinic visits after integration. Healthcare workers reported that the main cause of non-adherence among users with diabetes and hypertension was poverty. Participants with diabetes and hypertension reported they could not afford private clinical investigations or purchase drugs prior to the establishment of the integrated clinics. The strengthening of drug supply for non-communicable conditions in the integrated clinics was welcomed. Most participants observed that the integrated clinic reduced feelings of stigma for those living with HIV. Sharing the clinic afforded privacy about an individual’s condition, and users were comfortable with the waiting room sitting arrangement. We found that integrating non-communicable disease and HIV care had benefits for all users. Integrated care could be an effective model of care if service users have access to a reliable supply of basic medicines for both HIV and non-communicable disease conditions.

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Section: Discussionmentioning

confidence: 99%

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Bukenya

Hout

Shayo

et al. 2022

PLOS Glob Public Health

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“…The accessibility of care related-enablers for the implementation of both the EDL 96, 98, 103 and EML 48, 50, 53, 57, 64, 68, 69, 79, 83–85, 87, 104, 128, 133, 134 , are opposite to the barriers listed above.…”

Section: Resultsmentioning

confidence: 92%

“…The barriers related to the relationship with norms and standards for the EDL implementation included poor availability of diagnosis and management guidelines, noting the unavailability of diabetes guidelines in any surveyed clinics 165 . Other barriers unique to the EML included incompliance to guidelines 50,53,131,149,153,166,168,169 , incompliance to national EMLs 48,68,79,132,145,170 , lack of national EMLs in facilities 128,171 , disconnect between guidelines on treatment protocols 47,75 , disconnect between policy, guidelines and practice 46,167 , and lack of standard operating procedures 135 .…”

Section: Relationship With Norms and Standardsmentioning

confidence: 99%

Implementing essential diagnostics-learning from essential medicines: A scoping review

Nyanchoka

Mulaku

Nyagol

et al. 2022

Preprint

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Background The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on the implementation of the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. Methods We searched eight electronic databases for studies reporting on the implementation of the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesized findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies where applicable. Results We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n=129) included studies were purely quantitative in design comprising descriptive cross-sectional designs (60%, n=104), 15% (n=26) were purely qualitative, and 10% (n=17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about the EDL. The main barrier facing the EML and EDL was poorly equipped health facilities - including unavailability or stock-outs of essential in vitro diagnostics and medicines and inadequate infrastructure to enable health service delivery. Financial and non-financial incentives to health facilities and workers were a key enabler to the implementation of the EML however, their impact differed from one context to another. Fifty-six (33%) of the included studies were of high quality. Conclusions The EDL implementation at the national level can learn from health system interventions to improve the availability and supply of essential medicines such as financial and non-financial incentives in different contexts.

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“…In Uganda, long-acting insulin analogues including insulin glargine are currently not listed in the Ugandan EML ( Table 1 ). This is a concern in view of the high rates of hypoglycaemia currently seen; however, reflects issues of affordability in Uganda, which is a major issue ( 115 ). Currently, prices for insulin glargine within the healthcare system in Uganda vary between US$15–$35/pen depending on whether this is a biosimilar or originator, and whether hospital or community pharmacy.…”

Section: Resultsmentioning

confidence: 99%

The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

Godman

Haque

Leong

et al. 2021

Front. Public Health

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Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers.Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders.Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries.Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production.Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.

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Appropriateness and affordability of prescriptions to diabetic patients attending a tertiary hospital in Eastern Uganda: A retrospective cross-sectional study

Cited by 7 publications

References 23 publications

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Implementing essential diagnostics-learning from essential medicines: A scoping review

The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

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