Vialle-Valentin Catherine E, Serumaga Brian, Wagner Anita K, Ross-Degnan Dennis
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA.
Health Policy Plan. 2015 Oct;30(8):1044-52. doi: 10.1093/heapol/czu107. Epub 2014 Sep 24.
The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases.
2011年联合国大会关于预防和控制非传染性疾病的政治宣言将非传染性疾病提上了全球卫生议程。基本药物是治疗高血压和糖尿病等慢性病的核心。我们的研究旨在量化五个低收入和中等收入国家慢性病患者获取基本药物的情况，并评估家庭社会经济地位以及对药品可获得性和可负担性的认知如何影响获取情况。我们使用世界卫生组织（WHO）的标准方法，分析了2007年至2010年在加纳、约旦、肯尼亚、菲律宾和乌干达进行的全国性调查中1867名慢性病患者的数据，以衡量药品的获取和使用情况。如果个体报告定期服用已确诊慢性病的药物，且数据收集者在其家中发现了针对该疾病的药物，我们就将其定义为能够获取药物。我们使用考虑了整群调查设计的逻辑回归模型，来研究在家中储备药物的决定因素以及慢性病患者获取药物的预测因素。在每个国家，之前被诊断患有慢性病的个体中，不到一半的人能够获取治疗其疾病的药物，从乌干达的16%到约旦的49%不等。除了报告患有慢性病外，家庭社会经济水平较高是家中有任何药物的最显著预测因素。有药品保险覆盖的人获取慢性病药物的可能性更高[最高调整优势比（OR）为3.12（95%置信区间（CI）：1.38，7.07）]，而有借钱支付药费既往史的人可能性更低[最低调整OR为0.56（95%CI：0.34，0.92）]。我们的研究记录了在五个资源有限的环境中，慢性病患者获取基本药物的情况较差。它凸显了在全球改善慢性病治疗的努力中，财务风险保护和关于通用药物的消费者教育的重要性。
