Access to Care for Multiple Sclerosis in Times of Economic Crisis in Greece--the HOPE II Study.

Kyriakos Souliotis,Panagiota Litsa,Manto Papageorgiou,Elena Alexopoulou,Anastasia Politi,Xenophon Contiades

doi:10.15171/ijhpm.2015.173

Abstract

While there is currently no cure for multiple sclerosis (MS), treatment with biologic disease-modifying drugs (bDMDs) can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (ESY) hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients' experiences. A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socio-economic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period. During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties. Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry.

Highlights

The dimensions of quality in health according to Maxwell[1] are accessibility, equality, responsiveness to the needs of patients and the community, social acceptance, efficiency, and effectiveness
During the last two years, Greek multiple sclerosis (MS) patients have abruptly moved from a status of unrestricted and fairly easy access to biologic disease-modifying drugs (bDMDs) to a complex distribution system which has limited their access to effective treatment
The latest regulatory change in the distribution system of high-cost, fully reimbursed, medicines, including bDMDs for MS, has limited access to high-cost pharmaceuticals, by allowing their administration only through the publicly-owned, designated pharmacies of the National Organization for Healthcare Provision (EOPYY) or the National Health System (ESY) hospitals (medicines administered by hospitals if: (a) the medicine is administered by intravenous infusion and is only for hospital use, or (b) the use of the medicine must start under hospital monitoring and can be continued outside the hospital but under hospital surveillance, according to its packaging information –“blue box”), and only when their prescription is accompanied by an appropriate medical diagnosis issued by a hospital physician

Summary

Introduction

The dimensions of quality in health according to Maxwell[1] are accessibility, equality, responsiveness to the needs of patients and the community, social acceptance, efficiency, and effectiveness. The latest regulatory change in the distribution system of high-cost, fully reimbursed, medicines (ie, medicines defined by Law 3816/2010), including bDMDs for MS, has limited access to high-cost pharmaceuticals, by allowing their administration only through the publicly-owned, designated pharmacies of the National Organization for Healthcare Provision (EOPYY) or the National Health System (ESY) hospitals (medicines administered by hospitals if: (a) the medicine is administered by intravenous infusion and is only for hospital use, or (b) the use of the medicine must start under hospital monitoring and can be continued outside the hospital but under hospital surveillance, according to its packaging information –“blue box”), and only when their prescription is accompanied by an appropriate medical diagnosis issued by a hospital physician The aim of this measure was to contain public pharmaceutical costs and to ensure that high-cost medicines such as bDMDs are prescribed according to official treatment guidelines and protocols.[10] In the light of this regulatory change, a recent study by Souliotis et al,[11] ie, HOPE I (Health Outcomes Patient Environment I) study, assessed access to high-cost medicine for the treatment for rheumatoid arthritis (disease-modifying antirheumatic drugs, DMARDs) in Greece, concluding that patients are facing increased barriers to access timely and effective treatment under the new distribution system. By collecting data on both medical and pharmaceutical MS treatment, we attempted to review access to MS care as a whole in the era of economic crisis in Greece

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