Barriers to accessing biologic treatment for rheumatoid arthritis in Greece: the unseen impact of the fiscal crisis—the Health Outcomes Patient Environment (HOPE) study

Abstract

The latest regulatory change in the distribution system of biologic disease-modifying, antirheumatic drugs limited their sale only through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (NHS) hospitals, adding to the complexity of access to effective treatment for rheumatoid arthritis (RA) in Greece. The aim of this paper was to assess the barriers to access RA treatment, by recording patients', rheumatologists' and EOPYY pharmacists' experiences. One twenty-three patients, 12 rheumatologists and 27 pharmacists from Athens and other urban areas in Greece participated in the study. Three types of standardized questionnaires were used to elicit information from each group of respondents using the method of personal interview for patients and the method of postal survey for doctors and pharmacists. During the last year, 26% of patients encountered problems in accessing their rheumatologist and 49% of patients experienced difficulties in accessing their medication. Ninety-two percent of rheumatologists and 96% of pharmacists confirmed that patients experience difficulties in accessing RA medication. The most commonly reported reasons for reduced access to medical treatment were travel difficulties and long distance from doctor's clinic, as well as delays in booking an appointment. The most frequently reported barriers to access pharmaceutical treatment were difficulties in the prescription process, distance from EOPYY pharmacies and medicine shortages in NHS hospitals. The study showed that RA patients are facing increased barriers to access timely and effective treatment. Redesign of the current system of distribution ensuring the operation of additional points of sale is deemed necessary.

Healthcare access for cancer patients in the era of economic crisis. Results from the HOPE III study

“…Findings from this study are in line with those of the HOPE I and II studies (8,9) for patients with In 2012, patients experiencing rheumatoid arthritis also cited difficulties in accessing medication, the long geographical distance from health services, the long waiting lists for appointment and the low availability of medicines from NHS hospitals as the main inhibitors for access to the treatment (8). Moreover, in 2014, the HOPE II study revealed that patients suffering from multiple sclerosis faced barriers such as problems in accessing medical and pharmaceutical treatment because of long distance from pharmacies and health services, the low availability of pharmaceutical medication and the financial burden of the out of pocket costs (9).…”

“…The first study (HOPE I) was conducted in 2012 and revealed that a large majority of patients with rheumatoid arthritis experiencing significant difficulties in accessing medication. Furthermore, the most common barriers to treatment was the geographical distance from physician's setting, the long waiting lists for appointment as well as the low availability of medicines from National Health Service (NHS) hospitals and the complicated prescription process (8). The second study (HOPE II) was carried out in 2014 and revealed that same barriers do also exist for patients suffering from multiple sclerosis (9).…”

Access to Care for Multiple Sclerosis in Times of Economic Crisis in Greece – the HOPE II Study

“…7,[12][13][14][15] Yet, despite the improvement in the operation of the distribution system, problems still exist, with one in eight MS patients reporting barriers in accessing bDMDs. Similarly to the previous HOPE I study, 11 the distance from EOPYY pharmacies continued to present a major obstacle for patients, while other obstacles were related to the difficulties in obtaining the required medical diagnosis by an ESY/EOPYY physician, and to the reduced accessibility of patients to their treating physician. These barriers could be overcome through the development of an MS national registry which would standardize the distribution process (and home delivery) and assure comprehensive, and faster patient access to treatment.…”

“…This resulted in anxiety, confusion and discomfort for patients, who often had to travel long distances to ensure access to their medicines. As shown in the HOPE I study by Souliotis et al, 11 one in 2 patients with RA reported problems in accessing biologic DMARDs during 2012 through the new system, which they attributed to the long distance from EOPYY pharmacies, difficulties in accessing a prescribing a Treatment requiring or not short-term hospitalization. doctor and to the non-availability or difficulty of finding their medication at an ESY hospital or EOPYY pharmacy.…”

“…The aim of this measure was to contain public pharmaceutical costs and to ensure that high-cost medicines such as bDMDs are prescribed according to official treatment guidelines and protocols. 10 In the light of this regulatory change, a recent study by Souliotis et al, 11 ie, HOPE I (Health Outcomes Patient Environment I) study, assessed access to high-cost medicine for the treatment for rheumatoid arthritis (disease-modifying antirheumatic drugs, DMARDs) in Greece, concluding that patients are facing increased barriers to access timely and effective treatment under the new distribution system. In this context, the objective of the present study, ie, HOPE II, was to assess the operation of the high-cost medicine distribution system one year later, and in another disease area, ie, in MS, based on the experiences of patients.…”