Providing a framework for assessment of the access to medicine

Abstract

Objective Improving access to effective and safe medicines is one of the major goals of all health systems. To achieve this goal, assessment is a fundamental phase of national medicine programs for access improvement. Collecting and compiling applicable indicators and impart a comprehensive framework for assessing access to medicine, are the aims of this study. Methods To investigate the published materials on access to medicines framework or indicators, a literature review with a systematic search was conducted using PubMed/ Medline, Scopus, and Google Scholar databases. The results were completed with a general search of documents in Iran Food and Drug Administration (IRFDA). Two independent researchers reviewed all the articles and documents. Thereafter the related indicators were extracted. In focused group discussion of academics and IRFDA experts, duplicate entries or ineffectual concepts were cleaned from the preliminary indicators. In the next step, Delphi questionnaire was sent to the 17 experts that work in academia, Social Security Insurance, IRFDA, Ministry of Health and Iran Pharmacist Association. The results of Delphi technique were finalized in an expert panel. Results One hundred and thirty one indicators were found in systematic search. After primary extraction of related indicators, 77 indicators were sent to the 17 experts in a Delphi form. The results of Delphi were finalized in a specialized-working group and 67 indicators were accepted in 5 categories including physical availability and geographical accessibility (19 indicators), affordability (23 indicators), human resources (4 indicators), quality and safety (5 indicators), information and rational use (16 indicators). Conclusion The indicators that inclusively assess the full access to medicine in the concept of rational use have been categorized into five categories in this study. To determine the access to medicine status in each country further local surveys are necessary for all several indicators in each category. Keywords Health services accessibility. Access to medicine. Accessibility. Availability. Pharmaceutical services. Health status indicators. BHealth care quality. Access. and Evaluation^. Affordability. BCosts and cost analysis^. Health policy. National medicine program. Pharmaceutical policy

Perceptions of diabetes patients and their caregivers regarding access to medicine in a severely constrained health system: A qualitative study in Harare, Zimbabwe

“…They considered multiple levels of organization from the household level to the international context (Fig 1). Among a set of extant access to medicines frameworks [6][7][8][9][10][11][12][13][14][15] this framework (Bigdeli et al's framework [9]) was found to be the most comprehensive conception yet of what access to medicine entails. Therefore, this framework's domains formed the basis of our coding scheme outlined in S1 Data.…”

“…These diabetes policies must be attentive to factors affecting access to medicines for diabetes patients because the key to effective diabetes management includes adherence to insulin and oral medicines [6,7]. Among the several frameworks conceptualising the access to medicines and health technologies [6][7][8][9][10][11][12][13][14][15], two of the most recently published [6,7] relate specifically to medicines for cardiovascular diseases and diabetes, suggesting the recognition of the unique salience of diabetes and cardiovascular diseases. 'Access to medicine' is defined here as the multi-dimensional construct that characterises the degree to which quality and safe medicines are available, affordable, accessible and acceptable in a timely manner to those needing them [6][7][8][9][10][11][12][13][14][15].…”

“…Among the several frameworks conceptualising the access to medicines and health technologies [6][7][8][9][10][11][12][13][14][15], two of the most recently published [6,7] relate specifically to medicines for cardiovascular diseases and diabetes, suggesting the recognition of the unique salience of diabetes and cardiovascular diseases. 'Access to medicine' is defined here as the multi-dimensional construct that characterises the degree to which quality and safe medicines are available, affordable, accessible and acceptable in a timely manner to those needing them [6][7][8][9][10][11][12][13][14][15]. Beran et al, [6], described a framework for promoting diabetic patients' access to insulin.…”

Consumers’ access to information about medicine prices and availability as an enabler of last mile medicine access: A scoping review

“…Pursuing leads on potentially relevant authors and publications, based on personal communications from colleagues, also proved useful for identifying published ATM frameworks. These works 48 – 50 were identified this way.…”

“…Afzali et al 48 To provide an evidence-based framework for evaluating access to medicine using a system approach, with indicators disaggregated by inputs, outputs and outcomes Information provision about benefits, side effects, use of medicines at the point of dispensing is conceptualised as one of the indicators of access.…”