Dewi Aksari, Pisani Elizabeth, Ihsan Bachtiar Rifai Pratita, Hariadini Ayuk Lawuningtyas, Patel Anushka, Palagyi Anna, Praveen Devarsetty, Lyrawati Diana
The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Department of Pharmacy, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia.
J Pharm Policy Pract. 2023 Mar 22;16(1):50. doi: 10.1186/s40545-022-00509-w.
In Indonesia, the world's fourth most populous country, cardiovascular diseases (CVDs) are a leading cause of death and disability. Government efforts to reduce the burden of CVD include a community-based prevention and early detection programme, and the provision of medicines to prevent cardiovascular events. Disruptions to medicine supply chains, service provision, and movement during the COVID-19 pandemic potentially threatened the continuity of these efforts. We investigated the distribution and dispensing of common CVD medicines in Malang district, East Java, before the pandemic and early in its course.
From January to October 2020, we collected monthly data on stock levels, sales or dispensing volumes, and price for five common CVD medicines (amlodipine, captopril, furosemide, glibenclamide and simvastatin), from a public and a private distributor, and from public health facilities (n = 4) and private pharmacies (n = 2). We further complied monthly data on patient numbers in two primary health centres. We tracked changes in stocks held and volumes dispensed by medicine type and sector, comparing the three months before the local COVID-19 response was mobilised with the subsequent seven months. We conducted interviews with pharmacists (n = 12), community health workers (n = 2) and a supply chain logistics manager to investigate the reasons for observed changes, and to learn details of any impacts or mitigation measures.
The pandemic affected demand more than supply, causing medicine stocks to rise. Restricted service provision, lock-down measures and fear of infection contributed to a sharp drop in patient numbers and dispensing volumes in the public sector. Meanwhile private sector sales, especially of lower-priced CVD medicines, rose. Community health workers attributed some poor health outcomes to interruption in regular patient check-ups; this interruption was aggravated by formal mitigation policies.
Fears that COVID-19 would interrupt medicine availability were unfounded in East Java. Public sector patients may have compensated for reduced service access by switching to private pharmacies. Mitigation policies that ignored administrative procedures were not effective.
在世界第四人口大国印度尼西亚，心血管疾病（CVD）是导致死亡和残疾的主要原因。政府减轻心血管疾病负担的努力包括一项基于社区的预防和早期检测计划，以及提供预防心血管事件的药物。在2019冠状病毒病大流行期间，药品供应链、服务提供和人员流动的中断可能威胁到这些努力的连续性。我们调查了爪哇东部玛琅地区在大流行之前及其初期常见心血管疾病药物的分发和配药情况。
2020年1月至10月，我们每月收集来自一家公共和一家私人经销商、公共卫生机构（n = 4）和私人药店（n = 2）的五种常见心血管疾病药物（氨氯地平、卡托普利、呋塞米、格列本脲和辛伐他汀）的库存水平、销售或配药量以及价格数据。我们还每月收集两个初级卫生中心的患者人数数据。我们按药物类型和部门跟踪库存和配药量的变化，将当地动员应对2019冠状病毒病之前的三个月与随后的七个月进行比较。我们采访了药剂师（n = 12）、社区卫生工作者（n = 2）和一名供应链物流经理，以调查观察到的变化的原因，并了解任何影响或缓解措施的细节。
大流行对需求的影响大于对供应的影响，导致药品库存增加。服务提供受限、封锁措施和对感染的恐惧导致公共部门患者人数和配药量急剧下降。与此同时，私营部门的销售额，尤其是低价心血管疾病药物的销售额有所上升。社区卫生工作者将一些健康状况不佳归因于定期患者检查的中断；正式的缓解政策加剧了这种中断。
在东爪哇，担心2019冠状病毒病会中断药品供应是没有根据的。公共部门的患者可能通过转向私人药店来弥补服务获取的减少。忽视行政程序的缓解政策无效。
