University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
129263University of Colorado Anschutz Medical Campus, Centre for Bioethics and Humanities, Aurora, Colorado, United States.
Policy Polit Nurs Pract. 2023 Feb;24(1):67-75. doi: 10.1177/15271544221121749. Epub 2022 Sep 7.
An increasing proportion of new drugs approved for market worldwide are now high cost, specialty medicines. Pharmaceutical marketers face the challenge of convincing payers, prescribers, and patients that the cost and complexity of care associated with specialty medicines is worth the trouble, and now offer patient support programs, free of charge, to patients prescribed their drug. We conducted a secondary, qualitative, interpretive analysis of 24 interviews with leaders of patient groups and members of hospital formulary committees in Australia to describe the work of pharmaceutical company-employed or contracted nurses who provide support to patients prescribed specialty medicines, and to prompt discussion around the policy implications of relying on industry-funded nursing care within publicly funded health systems. Participants affirmed the value of specialist, holistic, person-centered nursing care, but perceived gaps within the public health system related to the availability and provision of nursing care for people living with chronic disease. Consequently, participants described the pharmaceutical industry as addressing health system gaps through sponsorship or direct provision of medication-related nursing care, but recognized that care was contingent on commercial interest. Participants highlighted a number of ethical and policy concerns stemming from industry-funded nursing care of people prescribed specialty medicines related to patient safety, continuity of care, inducement to prescribe, and health equity. This analysis suggests that outsourcing necessary medication-related care to pharmaceutical companies has implications for the health system and equitable, sustainable pharmaceutical policy that extend far beyond the care encounter.
目前，全球获批上市的新药中，越来越多的是高成本的专科药物。制药商面临着这样的挑战，即要说服支付方、开方者和患者相信，与专科药物相关的治疗成本和复杂性是值得的，现在他们向开处方者的患者提供免费的患者支持计划。我们对澳大利亚的患者团体领导人和医院处方委员会成员进行了 24 次访谈的二次定性解释性分析，以描述为开处专科药物的患者提供支持的制药公司雇用或签约护士的工作，并就依靠行业资助的护理在公共资助的卫生系统内的政策影响展开讨论。参与者肯定了专科、全面、以患者为中心的护理的价值，但认为公共卫生系统在为慢性病患者提供护理方面存在一些不足。因此，参与者将制药行业描述为通过赞助或直接提供与药物相关的护理来解决卫生系统的差距，但认识到护理取决于商业利益。参与者强调了一些与行业资助的专科药物处方患者的护理相关的伦理和政策问题，这些问题涉及患者安全、护理的连续性、开处方的诱导以及卫生公平性。这项分析表明，将必要的药物相关护理外包给制药公司，对卫生系统和公平、可持续的药物政策产生影响，这些影响远远超出了护理的范围。
