Department of Neuroscience,Biomedicine and Movement Sciences,Section of Psychiatry,WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation,University of Verona,Italy.
Department of Mental Health and Substance Abuse,World health Organization,Geneva,Switzerland.
Epidemiol Psychiatr Sci. 2017 Oct;26(5):481-490. doi: 10.1017/S2045796016001165. Epub 2017 Jan 9.
In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013-2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use.
Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines.
A 4 × 4 framework mapping actions as a function of the four components of access - selection, availability, affordability and appropriate use - and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines.
Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.
近年来，为了提高各国改善基本药物获取机会的能力，特别是针对精神障碍的药物获取机会，已采取了若干政府间举措。2013 年 5 月，第 66 届世界卫生大会通过了 2013-2020 年世界卫生组织（世卫组织）精神卫生综合行动计划，该计划是在世卫组织精神卫生差距行动规划的基础上制定的。在此规划框架内，制定了精神障碍循证指南，包括关于适当使用药物的建议。随后，第 67 届世界卫生大会通过了一项关于基本药物获取机会的决议，敦促会员国改善国家基本药物选择政策，并促进基本药物的可及性、可负担性和适当使用。
借鉴这些重要举措，本文提出了 11 项改善精神药物获取机会和适当使用的行动。
开发了一个 4×4 框架，将行动映射为获取机会的四个组成部分（选择、供应、可负担性和适当使用）的功能，并跨越四个不同的医疗保健层面，其中三个层面属于供应方，一个层面属于需求方。这些行动包括：制定药物选择程序；为医护人员和终端用户开展宣传和教育活动；制定药物监管程序；实施可靠的供应系统；实施可靠的质量控制体系；开发以社区为基础的精神卫生保健系统并促进寻求帮助行为；制定关于药物可负担性的国际协议；制定定价政策和可持续供资系统；制定或采用循证指南；监测精神药物的使用情况；为医护人员和终端用户开展关于对科学证据进行批判性评估和适当使用精神药物的培训活动。
激活这些行动提供了一个独特的机会，可解决扩大获取精神障碍治疗和护理机会的更广泛问题，因为目前对精神障碍的关注不足是 4×4 获取框架所有领域的核心障碍。
