Identifying the most effective essential medicines policies for quality use of medicines: A replicability study using three World Health Organisation data-sets.

Kathleen Anne Holloway,Mathaiyan Jayanthi,Gilles Forte,Solaiappan Manikandan,David Henry,Anbarasan Mohan,Verica Ivanovska,Russell Kabir

doi:10.1371/journal.pone.0228201

Abstract

Poor quality use of medicines (QUM) has adverse outcomes. Governments' implementation of essential medicines (EM) policies is often suboptimal and there is limited information on which policies are most effective. We analysed data on policy implementation from World Health Organisation (WHO) surveys in 2007 and 2011, and QUM data from surveys during 2006-2012 in developing and transitional countries. We compared QUM scores in countries that did or did not implement specific policies and regressed QUM composite scores on the numbers of policies implemented. We compared the ranking of policies in this and two previous studies, one from the same WHO databases (2003-2007) the other from data obtained during country visits in South-East Asia (2010-2015). The rankings of a common set of 17 policies were correlated and we identified those that were consistently highly ranked. Fifty-three countries had data on both QUM and policy implementation. Forty policies were associated with effect sizes ranging from +13% to -5%. There was positive correlation between the composite QUM indicator and the number of policies reported implemented: (r) = 0.437 (95% CI 0.188 to 0.632). Comparison of policy rankings between the present and previous studies showed positive correlation with the WHO 2003-7 study: Spearman's rank correlation coefficient 0.498 (95% CI 0.022 to 0.789). Across the three studies, five policies were in the top five ranked positions 11 out of a possible 15 times: drugs available free at the point of care; a government QUM unit; undergraduate training of prescribers in standard treatment guidelines, antibiotics not available without prescription and generic substitution in the public sector. Certain EM policies are associated with better QUM and impact increases with co-implementation. Analysis across three datasets provides a policy short-list as a minimum investment by countries trying to improve QUM and reduce antimicrobial drug misuse.

Highlights

Suboptimal use of medicines is widespread, wasteful, and causes poor patient outcomes including anti-microbial drug resistance [1,2,3,4,5,6,7,8,9]
Evidence from studies that we conducted in public healthcare sectors in developing and transitional countries suggests that implementation of World Health Organisation (WHO) essential medicines (EM) policies is associated with better quality use of medicines (QUM), including more appropriate use of anti-microbial agents [12,13,14]
Supporting information (S1 Table) describes the 13 QUM indicators and 3 policy indicators obtained from the WHO medicines use database, by country together with the survey references

Summary

Introduction

Suboptimal (irrational, incorrect, inappropriate) use of medicines is widespread, wasteful, and causes poor patient outcomes including anti-microbial drug resistance [1,2,3,4,5,6,7,8,9]. We accessed a second source of data collected during 2-week visits to countries in South-East Asia during 2010–15, where policy implementation was observed independently [14] The analyses of these data confirmed several of the findings of the earlier studies [12,13], including a correlation between the total numbers of EM policies implemented and composite measures of QUM. It remains unclear which policies are associated with the largest beneficial effects on medicines use. Governments’ implementation of essential medicines (EM) policies is often suboptimal and there is limited information on which policies are most effective

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Discussion

Conclusion