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2.
Washington; Organización Panamericana de la Salud; ago 25, 2020. 28 p.
Não convencional em Espanhol | LILACS | ID: biblio-1117908

RESUMO

En el transcurso de la pandemia de COVID-19, numerosos países, de ingresos bajos, medianos y alto, han visto agotadas sus reservas de medicamentos esenciales necesarios para el manejo de los pacientes con COVID-19 en las unidades de cuidados intensivos (UCI). El plan de preparación para emergencias sanitarias de los países requiere incluir una lista de medicamentos esenciales y otros dispositivos médicos necesarios en las UCI para afrontar emergencias sanitarias. La lista de medicamentos esenciales para el manejo de pacientes que ingresan a unidades de cuidados intensivos con sospecha o diagnóstico confirmado de COVID-19 es un documento de orientación fundamental que ayuda a los sistemas de salud de los países a priorizar los medicamentos esenciales que deben estar ampliamente disponibles y ser asequibles para manejar los pacientes en las UCI durante las situaciones de emergencia sanitaria, en este caso con sospecha o diagnóstico confirmado de COVID-19. Está dirigida a las autoridades sanitaras y a los encargados del manejo del sistema de salud de los países. Esta lista incluye fundamentalmente los medicamentos considerados esenciales para el manejo de los cuadros clínicos que con se observan con mayor frecuencia en pacientes hospitalizados en UCI a causa de una infección por SARS-CoV-2. No se incluyen la mayoría de los medicamentos que comúnmente se encuentran en las UCI para el manejo de otras patologías, comorbilidades o la estabilización del paciente (p. ej., insulina o antihipertensivos), salvo aquellos que pueden requerirse para el tratamiento o apoyo (p. ej., bloqueantes neuromusculares o anestésicos) de las dolencias generadas por la infección. Tampoco se incluyen medicamentos específicos para el tratamiento de la infección por SARS-CoV-2, puesto que no existe, por el momento, evidencia científica de alta calidad que avale su uso, salvo en el contexto de ensayos clínicos controlados. Un equipo de expertos en el tema realizó una búsqueda de información sobre la atención de pacientes en UCI durante la pandemia de COVID-19, en Medline (a través de PubMed), Cochrane, Tripdatabase, Epistemonikos y en buscadores generales de internet (Google). Se identificaron también revisiones o guías generadas por ministerios de Salud de varios países de la Región de las Américas, la Organización Mundial de la Salud (OMS), la Organización Panamericana de la Salud (OPS), el Instituto Nacional de Salud y Excelencia Clínica (NICE) de Reino Unido, los Centros para el Control y la Prevención de Enfermedades (CDC) de Estados Unidos y los Institutos Nacionales de Salud (NIH) de Estados Unidos.


Assuntos
Humanos , Criança , Adulto , Pneumonia Viral/tratamento farmacológico , Succinilcolina/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Administração dos Cuidados ao Paciente/organização & administração , Dexametasona/uso terapêutico , Corticosteroides/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Medicamentos Essenciais/provisão & distribução , Dexmedetomidina/uso terapêutico , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Antipiréticos/uso terapêutico , Pandemias/prevenção & controle , Betacoronavirus/efeitos dos fármacos , Haloperidol/uso terapêutico , Analgésicos Opioides/uso terapêutico , Unidades de Terapia Intensiva/organização & administração , Anti-Infecciosos/uso terapêutico , Pneumonia Viral/prevenção & controle , Respiração Artificial/enfermagem , Choque Séptico/prevenção & controle , Tromboembolia/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Medicina Baseada em Evidências , Intubação/enfermagem , Hipóxia/tratamento farmacológico
3.
Aust J Gen Pract ; 49(8): 530-532, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32738870

RESUMO

BACKGROUND: During the COVID-19 pandemic, vulnerable and older people with chronic and complex conditions have self-isolated in their homes, potentially limiting opportunities for consultations to have medications prescribed and dispensed. OBJECTIVE: The aim of this article is to describe initiatives to ensure ongoing access to medications during the COVID-19 pandemic. DISCUSSION: Cooperation between wholesalers and purchase limits in pharmacies have helped to ensure supply of essential medications. Therapeutic substitution by pharmacists is permitted for specific products authorised by the Therapeutic Goods Administration. Prescribers are permitted to issue digital image prescriptions, and implementation of electronic prescribing has been fast-tracked. Expanded continued dispensing arrangements introduced during the bushfire crises have been temporarily extended. Pharmacists are permitted to provide medication management reviews via telehealth. A Home Medicines Service has been introduced to facilitate delivery of medications to people who are vulnerable or elderly. Anticipatory prescribing and medication imprest systems are valuable for access to end-of-life medications within residential aged care.


Assuntos
Infecções por Coronavirus , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/organização & administração , Conduta do Tratamento Medicamentoso , Pandemias , Assistência Farmacêutica , Pneumonia Viral , Idoso , Austrália/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Prescrição Eletrônica , Humanos , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/tendências , Múltiplas Afecções Crônicas/terapia , Pandemias/prevenção & controle , Assistência Farmacêutica/organização & administração , Assistência Farmacêutica/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/tendências
4.
Einstein (Sao Paulo) ; 18: eAO5314, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32785451

RESUMO

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval - 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adulto , Idoso , Brasil , Cidades , Estudos Transversais , Medicamentos Essenciais/provisão & distribução , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Preparações Farmacêuticas/provisão & distribução , Medicamentos sob Prescrição/provisão & distribução , Fatores Socioeconômicos , Adulto Jovem
6.
Indian J Public Health ; 64(Supplement): S211-S216, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-556767

RESUMO

Health systems' responsiveness is the key to addressing infectious disease threats such as pandemics. The article outlines an assessment of health systems based on World Health Organization's building blocks for select countries. It also compares these with the findings from a more comprehensive analysis of Global Health Security (GHS) Index, which assesses the preparedness of the health system for such pandemics. The GHS report (2019) spelt out very objectively that none of the countries of the world was prepared to effectively handle such emergencies, should they arise. Observations emerging from different countries highlight these findings although some of them seem to be discordant. Overall, it appears that Asian countries could fight the battle better than most developed nations in the Europe and America during the current pandemic, despite having poor GHS scores. Experiences of these countries in facing similar crisis in the past probably sensitized their strained health systems for a greater good. There are several lessons to be learned from such countries.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Saúde Global , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus , Assistência à Saúde/normas , Medicamentos Essenciais/provisão & distribução , Sistemas de Informação em Saúde/organização & administração , Mão de Obra em Saúde/organização & administração , Humanos , Organização Mundial da Saúde
8.
Indian J Public Health ; 64(Supplement): S211-S216, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32496257

RESUMO

Health systems' responsiveness is the key to addressing infectious disease threats such as pandemics. The article outlines an assessment of health systems based on World Health Organization's building blocks for select countries. It also compares these with the findings from a more comprehensive analysis of Global Health Security (GHS) Index, which assesses the preparedness of the health system for such pandemics. The GHS report (2019) spelt out very objectively that none of the countries of the world was prepared to effectively handle such emergencies, should they arise. Observations emerging from different countries highlight these findings although some of them seem to be discordant. Overall, it appears that Asian countries could fight the battle better than most developed nations in the Europe and America during the current pandemic, despite having poor GHS scores. Experiences of these countries in facing similar crisis in the past probably sensitized their strained health systems for a greater good. There are several lessons to be learned from such countries.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Saúde Global , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus , Assistência à Saúde/normas , Medicamentos Essenciais/provisão & distribução , Sistemas de Informação em Saúde/organização & administração , Mão de Obra em Saúde/organização & administração , Humanos , Organização Mundial da Saúde
9.
Bull World Health Organ ; 98(6): 413-419, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514215

RESUMO

Objective: To obtain the perspectives of some small- and medium-sized organizations on the World Health Organization (WHO) prequalification programme for medicines and to ascertain organizations' unmet needs. Methods: We conducted an exploratory, qualitative study in 2018 among 17 representatives of 15 small- and medium-sized Belgian and non-Belgian organizations who purchase medicines for humanitarian, development or public programmes in low- and middle-income countries. We used semi-structured interviews to obtain respondents' views and experiences of using WHO prequalification guidance when procuring medicines. We identified emerging themes and formulated recommendations about the activities of the WHO Prequalification Team. Findings: Most respondents suggested expanding prequalification to essential antibiotics, particularly paediatric formulations; and insulin, antihypertensives and cancer treatments. Respondents were concerned about irregular availability of WHO-prequalified medicines in the marketplace and sometimes high prices of prequalified products. Small organizations, in particular, had difficulties negotiating low-volume purchases. Organizations working in primary health care and hospitals seldom referred to the prequalified lists. Conclusion: We recommend that the WHO-prequalified products be expanded to include essential antibiotics and medicines for noncommunicable diseases. The WHO Prequalification Team could require prequalified manufacturers to make publicly available the details of their authorized distributors and facilitate a process of harmonization of quality assurance policies across all donors. Prequalification of distributors and procurement agencies could help create more transparent and stringent mechanisms. We urge WHO Member States and funders to sustain support for the WHO Prequalification Team, which remains important for the fulfilment of universal health coverage.


Assuntos
Medicamentos Essenciais/provisão & distribução , Saúde Global , Organizações/organização & administração , Medicamentos sob Prescrição/provisão & distribução , Organização Mundial da Saúde/organização & administração , Antibacterianos/provisão & distribução , Humanos , Doenças não Transmissíveis/tratamento farmacológico , Organizações/normas , Pesquisa Qualitativa
11.
BMC Health Serv Res ; 20(1): 234, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32192481

RESUMO

BACKGROUND: Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process. METHOD: Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes. RESULTS: The 'Procurement process' emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals. CONCLUSIONS: Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.


Assuntos
Medicamentos Essenciais/provisão & distribução , Hospitais Públicos , Serviço Hospitalar de Compras/organização & administração , Adulto , Contratos , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , África do Sul
12.
Expert Rev Clin Pharmacol ; 13(2): 191-200, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31914825

RESUMO

Background: In 2018, China implemented the latest National Essential Medicines List (NEML) by enhancing the NEML 2012. The goal of our studies is to analyze the changes in the two lists and compared them with the 20th EML issued by WHO in 2017. And then provide suggestions for emerging problems.Method: The overall composition of the categories, specific drugs, characteristics, advantages and disadvantages of the lists were compared by descriptive analysis. The neuropsychiatric disorders system medicines and patented medicines were analyzed to illustrate the changes of NEML.Results: In 20th WHO-EML, the largest increase was the medicines used for children (13 to the core list and 12 to the complementary list). In 2018 NEML, rounding out the top were medicines used for cardiovascular system. Among the 120 new medicines, 30 new medicines were included in 2017 WHO-EML. Eleven patented medicines were new-added in NEML; however, 8 was not included in WHO-EML.Conclusion: China has a large population, and the territorial development is uneven. Although the essence of EMLs is a limited list, NEML should enlarge the choices properly. 2018 NEML provides a comprehensive coverage of diseases. Some of the medicines, including high-priced medicines that were not recommended by WHO.


Assuntos
Medicamentos Essenciais/provisão & distribução , Preparações Farmacêuticas/provisão & distribução , Criança , China , Custos de Medicamentos , Medicamentos Essenciais/economia , Humanos , Preparações Farmacêuticas/economia , Organização Mundial da Saúde
13.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
14.
PLoS One ; 14(12): e0226169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31834889

RESUMO

OBJECTIVES: To explore availability, prices and affordability of essential medicines for diabetes and hypertension treatment in private pharmacies in three provinces of Zambia. METHODS: A cross-sectional survey was conducted in 99 pharmacies across three Zambian provinces. Methods were based on a standardized methodology by the World Health Organization and Health Action International. Availability was analysed as mean availability per pharmacy and individual medicine. Median prices were compared to international reference prices and differences in price between medicine forms (original brand or generic product) were computed. Affordability was assessed as number of days' salaries required to purchase a standard treatment course using the absolute poverty line and mean per capita provincial household income as standard. An analysis identifying medicines considered both available and affordable was conducted. RESULTS: Two antidiabetics and nine antihypertensives had high-level availability (≥80%) in all provinces; availability levels for the remaining surveyed antidiabetics and antihypertensives were largely found below 50%. Availability further varied markedly across medicines and medicine forms. Prices for most medicines were higher than international reference prices and great price variations were found between pharmacies, medicines and medicine forms. Compared to original brand products, purchase of generics was associated with price savings for patients between 21.54% and 96.47%. No medicine was affordable against the absolute poverty line and only between four and eleven using mean per capita provincial incomes. Seven generics in Copperbelt/Lusaka and two in Central province were highly available and affordable. CONCLUSIONS: The study showed that the majority of surveyed antidiabetic and antihypertensive medicines was inadequately available (<80%). In addition, most prices were higher than their international reference prices and that treatment with these medicines was largely unaffordable against the set affordability thresholds. Underlying reasons for the findings should be explored as a basis for targeted policy initiatives.


Assuntos
Anti-Hipertensivos/provisão & distribução , Comércio/economia , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hipoglicemiantes/provisão & distribução , Farmácias/economia , Setor Privado/economia , Anti-Hipertensivos/economia , Custos e Análise de Custo , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Medicamentos Essenciais/economia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , Hipoglicemiantes/economia , Zâmbia/epidemiologia
15.
Health Policy Plan ; 34(Supplement_3): iii1-iii3, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816069

RESUMO

Nearly 2 billion people globally have no access to essential medicines. This means essential medicines are unavailable, unaffordable, inaccessible, unacceptable or of low quality for more than a quarter of the population worldwide. This supplement demonstrates the implications of poor medicine access and highlights recent innovations to improve access to essential medicines by presenting new research findings from low- and middle-income countries (LMICs). These studies answer key questions such as: Can performance-based financing improve availability of essential medicines? How affordable are cardiovascular treatments for children? Which countries' legal frameworks promote universal access to medicines? How appropriately are people using medicines? Do poor-quality medicines impact equity? Answers to these questions are important as essential medicines are vital to the Sustainable Development Goals and are central to the goal of achieving Universal Health Coverage. Access to affordable, quality-assured essential medicines is crucial to reducing the financial burden of care, preventing greater pain and suffering, shortening the duration of illness, and averting needless disabilities and deaths worldwide. This supplement was organized by the Medicines in Health Systems Thematic Working Group of Health Systems Global, a membership organization dedicated to promoting health systems research and knowledge translation. The five studies in the supplement further our understanding by showcasing recent successes and challenges of improving access to quality-assured medicines through health systems in LMICs.


Assuntos
Países em Desenvolvimento , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde , Medicamentos Essenciais/economia , Medicamentos Essenciais/normas , Humanos , Legislação de Medicamentos , Cobertura Universal do Seguro de Saúde
16.
Health Policy Plan ; 34(Supplement_3): iii4-iii19, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816071

RESUMO

Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n = 55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.


Assuntos
Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Financiamento da Assistência à Saúde , Reembolso de Incentivo , Camarões , Indústria Farmacêutica , Pessoal de Saúde , Humanos , Farmácias/economia , Pesquisa Qualitativa
17.
Health Policy Plan ; 34(Supplement_3): iii20-iii26, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816074

RESUMO

Policies to improve access to medicines for children in low- and middle-income countries, such as Nigeria, should consider the growing threat of non-communicable diseases. The aim of this pilot study was to scope availability, price and affordability of essential cardiovascular medicines for children in selected states in Nigeria. The study was a descriptive longitudinal survey conducted in three phases. Availability was determined as percentage of facilities having the medicine on the survey date. Medicines with good availability (>80%) were noted. Prices were cross-referenced against international Reference Prices and the Nigerian National Health Insurance Scheme Prices. Affordability was calculated using the Least-Paid Government Worker method. For medicines compounded to improve availability, a model for calculating affordability was proposed. In Phase I, the availability of all 17 strengths of the cardiovascular medicines or diuretics listed in the Essential Medicines List for Children (2015) were surveyed in two conveniently selected states using the WHO/HAI questionnaire. Data were collected from 17 hospitals and pharmacies. Phases II and III focused on tablet formulations (enalapril, furosemide, hydrochlorothiazide and spironolactone) in three purposively selected state capitals: Lagos, Abuja and Yenagoa. In Phase II, 11 private pharmacies were surveyed in December 2016: Phase III tracked price changes in Abuja and Yenagoa in August 2018. Only furosemide and hydrochlorothiazide tablets had good availability. Oral liquids were unavailable. Prices for four generic oral tablets were 2-16× higher than the International Reference Prices; prices for two of these did not change significantly over the study period. Affordable medicines were generic furosemide and hydrochlorothiazide tablet. Where a fee is charged, compounded medicines were also not affordable. While the small sample sizes limit generalization, this study provides indicative data suggesting that prices for cardiovascular medicines remain high and potentially unaffordable in the private sector in these selected states, and when compounded. Regular systematic access surveys are needed.


Assuntos
Fármacos Cardiovasculares/economia , Fármacos Cardiovasculares/provisão & distribução , Custos e Análise de Custo/estatística & dados numéricos , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Criança , Composição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Nigéria , Farmácias/estatística & dados numéricos , Projetos Piloto , Setor Privado/estatística & dados numéricos , Inquéritos e Questionários
18.
BMC Health Serv Res ; 19(1): 973, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852546

RESUMO

BACKGROUND: Cardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon. METHODS: A cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in "Measuring medicine prices, availability, affordability and price components" (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries. RESULTS: A total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability. CONCLUSIONS: Except for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines.


Assuntos
Fármacos Cardiovasculares/economia , Fármacos Cardiovasculares/provisão & distribução , Doenças Cardiovasculares/tratamento farmacológico , Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Líbano , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Catar , Inquéritos e Questionários
19.
Health Policy Plan ; 34(Supplement_2): ii104-ii120, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31723963

RESUMO

Understanding how countries review their national standard treatment guidelines (STGs) and essential medicines list (EML) is important in the light of ever-changing trends in public health and evidence supporting the selection and use of medicines in disease management. This study examines the 2017 STGs and EML review process, the actors involved and how the list of medicines and disease conditions evolved between the last two editions. We examined expert committee reports, stakeholder engagement reports and the last two editions (2010, 2017) STGs and EML. The review process occurred in both bureaucratic and public arenas where various actors with varied power and interest engaged in ways to consolidate their influence with the use of evidence from research and practice. In the bureaucratic arena, a national medicines selection committee inaugurated by the Minister of Health assessed the 2010 edition through technical sessions considering the country's disease burden, hierarchical healthcare structure and evidence on safety and efficacy and expert opinion. To build consensus and ensure credibility service providers, professional bodies and healthcare managers scrutinized the assessed guidelines and medicines list in public arenas. In such public arenas, technical discussions moved towards negotiations with emphasis on practicability of the policies. Updates in the 2017 guidelines involved the addition of 64 new disease conditions in the STG, with the EML including 153 additional medicines and excluding 56 medicines previously found in the 2010 EML. Furthermore, the level of care categorization for Level 'A' [i.e. community-based health planning and services (CHPS)] and Level 'M' (i.e. midwifery and CHPS with a midwife) evolved to reflect the current primary healthcare and community mobilization activities for healthcare delivery in Ghana. Ghana's experience in using evidence from research and practice and engaging wide stakeholders can serve as lessons for other low and middle-income countries.


Assuntos
Medicamentos Essenciais/provisão & distribução , Medicamentos Essenciais/normas , Medicina Baseada em Evidências , Guias como Assunto/normas , Política de Saúde , Assistência à Saúde , Tratamento Farmacológico/normas , Gana , Humanos , Negociação , Atenção Primária à Saúde
20.
PLoS One ; 14(10): e0223769, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618273

RESUMO

OBJECTIVES: To assess the availability and affordability of oral anti-diabetic medicines in Shaanxi Province, Western China. METHODS: In 2015, the prices and availability of 8 anti-diabetic medicines covering 31 different dosage forms and strengths were collected in six cities of Shaanxi Province. A total of 72 public hospitals and 72 private pharmacies were sampled, using a modified methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Medicine prices were compared with international reference prices to obtain a median price ratio. For urban residents, affordability was assessed as the lowest-paid unskilled government workers to purchase cost of standard treatment in days' wages; for rural residents, days' net income was used. RESULTS: The mean availabilities of originator brands (OBs) and generics were 34.3% and 28.7% in public hospitals, and 44.1% and 64.4% in the private pharmacies. OBs and the lowest priced generics (LPGs) were procured at 12.38 and 4.52 times the international reference price in public hospitals, and 10.26 and 2.81 times the international reference prices in private pharmacies. Treatments with OBs were unaffordable even for urban residents. The affordability of the LPGs was good, except for acarbose, repaglinide and pioglitazone. CONCLUSIONS: Most anti-diabetic medicines cannot met the WHO's availability target (80% availability) in Shaanxi Province. The high prices of OBs had severely influenced the affordability of medicines, especially for the rural residents. Effective policies should be initiated to ensure the Chinese people a better access to more affordable anti-diabetic medicines.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Acesso aos Serviços de Saúde/economia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/provisão & distribução , Administração Oral , China , Custos e Análise de Custo , Estudos Transversais , Diabetes Mellitus/economia , Medicamentos Essenciais/administração & dosagem , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Medicamentos Genéricos/administração & dosagem , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Política de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Hipoglicemiantes/economia , Formulação de Políticas , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribução , Fatores Socioeconômicos , Inquéritos e Questionários
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