Stakeholder input in optimising medication access

Abstract

Background: Accessibility is being introduced as an additional pillar to the three main pillars in the pharmaceutical scenario: safety, efficacy and quality. Accessibility reflects the ability of an individual to obtain health services in a timely manner, based on their needs. It is crucial once medication is prescribed, accessibility allows more compliance and makes the challenges of compliance to medication for the patient an easier task. The aim of this study was to collect data on the causes of lack of accessibility to medicines in Malta and what the most problematic barrier of accessibility is. The study identifies opportunities for pharmacists in different sectors to support their patient when accessibility is challenging. Method: Discussions with the Medicines Intelligence and Access unit within the Medicines Authority (MMA), which is the Competent Authority, , and a community pharmacist were conducted with the objective of collecting factual data regarding the current availability issues. A questionnaire was formulated based on the main points gathered, directed to pharmacists to obtain their perception on pharmacist practices related to accessibility. The questionnaire was validated by a focus group made up of two regulatory pharmacists in the MMA and three community pharmacists. The questionnaire was distributed electronically and through on-site visits to selected pharmacies via convenience sampling Interview questions were formulated from questionnaire segments that needed further investigation. Interviews with a hospital pharmacist; community pharmacist; pharmaceutical distributor distributor and advanced pharmacist practitioner at the procurement unit in the government health service were conducted. Results: A total of 102 pharmacists from all sectors in Malta completed the questionnaire. The main barrier identified was out-of-stock medication, followed by unavailability of brands or dosage forms. Shortages were most evident relating to medication used to treat infections.. The most common strategies adopted by the pharmacists were change in brand and change in active ingredient where emphasis was placed on the pharmacists contribution to explain the rationale for any change and to discuss associated advantages and disadvantages, enabling the patient to make an informed decision. Conclusion: Pharmacists play a key role in improving accessibility by offering alternatives, educating patients, and informing regulatory bodies. A co-payment system was proposed to, replace the current tendering system in place within the public health service so as to reduce access barriers for patients requiring non-formulary medicines. Stricter enforcement of mandatory reporting of out-of-stock private market medicines to the competent authority was recommended so as to enable this information to be communicated to the public and allowing patients to seek alternatives before their supply is depleted. New frameworks need to be supported by clear rules and regulations in order to avoid confusion that comes along with innovation.