Distribution Of Essential Medicines Research Articles

Analysis of antimicrobial prescriptions in Primary Healthcare.

To evaluate prescription receipts for antimicrobial prescriptions prescribed in primary healthcare units in a capital city in the Northeast region of Brazil. An evaluative, analytical study. Information from the central distribution of essential medicines and the receipts of antimicrobial prescriptions were used. There were 2,232 prescription receipts analyzed, in which metronidazole (250 mg) was prescribed in 28% of the evaluated prescription receipts, the "pill" pharmaceutical form in 30.7%, and the "oral" administration form in 78.2%. In the prescriptions prescribed by nurses, 80.7% were intended for users with sexually transmitted infections. With the exception of the pharmaceutical form, only 34.7% of the prescriptions were in accordance with the Nursing protocol recommendations. There is still no information on the concentration (43.7%), the dosage (39.9%) and the treatment time (36.8%). The evaluated receipts of antimicrobial prescriptions do not accurately follow the guidelines of Resolution No. 20/2011, nor of the instituted Nursing protocol.

Effect on Treatment Adherence of Distributing Essential Medicines at No Charge

Nonadherence to treatment with medicines is common globally, even for life-saving treatments. Cost is one important barrier to access, and only some jurisdictions provide medicines at no charge to patients. To determine whether providing essential medicines at no charge to outpatients who reported not being able to afford medicines improves adherence. A multicenter, unblinded, parallel, 2-group, superiority, outcomes assessor-blinded, individually randomized clinical trial conducted at 9 primary care sites in Ontario, Canada, enrolled 786 patients between June 1, 2016, and April 28, 2017, who reported cost-related nonadherence. Follow-up occurred at 12 months. The primary analysis was performed using an intention-to-treat principle. Patients were randomly allocated to receive free medicines on a list of essential medicines in addition to otherwise usual care (n = 395) or usual medicine access and usual care (n = 391). The primary outcome was adherence to treatment with all medicines that were appropriately prescribed for 1 year. Secondary outcomes were hemoglobin A1c level, blood pressure, and low-density lipoprotein cholesterol levels 1 year after randomization in participants taking corresponding medicines. Among the 786 participants analyzed (439 women and 347 men; mean [SD] age, 51.7 [14.3] years), 764 completed the trial. Adherence to treatment with all medicines was higher in those randomized to receive free distribution (151 of 395 [38.2%]) compared with usual access (104 of 391 [26.6%]; difference, 11.6%; 95% CI, 4.9%-18.4%). Control of type 1 and 2 diabetes was not significantly improved by free distribution (hemoglobin A1c, -0.38%; 95% CI, -0.76% to 0.00%), systolic blood pressure was reduced (-7.2 mm Hg; 95% CI, -11.7 to -2.8 mm Hg), and low-density lipoprotein cholesterol levels were not affected (-2.3 mg/dL; 95% CI, -14.7 to 10.0 mg/dL). The distribution of essential medicines at no charge for 1 year increased adherence to treatment with medicines and improved some, but not other, disease-specific surrogate health outcomes. These findings could help inform changes to medicine access policies such as publicly funding essential medicines. ClinicalTrials.gov identifier: NCT02744963.

Improving Supply Chain for Essential Drugs in Low-Income Countries: Results from a Large Scale Randomized Experiment in Zambia

Despite increased investments in procurement of essential medicines, their availability at health facilities remains extremely low in many low- and middle-income countries. The lack of a well-functioning supply chain for essential medicines is often the cause of this poor availability. Using a randomized trial conducted in 439 health facilities and 24 districts in Zambia, this study helps understand the optimal supply chain structure for essential medicines distribution in the public sector in low-income countries. It shows that a more direct distribution system where clinics order and receive medicines supply directly from the central agency through a cross-docking arrangement significantly reduces the duration and frequency of stockouts compared to a traditional three-level drug distribution system. As an example, the frequency of stockouts for first line pediatric malaria medicines reduced from 47.9% to 13.3% and the number of days of stockout in a quarter reduced from 27 days to 5 days. The direct flow of demand and order information from health facilities to the central supply agency reduces the problem of diffuse accountability that exists in multi-tiered distribution systems. It also shifts the locus of decision making for complex supply chain functions such as scarce stock allocation and adjustment of health facility order quantities to levels in the system where staff competency is aligned with what the function needs. Even when supply chain system redesign such as the one evaluated in this paper are demonstrated to be technically robust using rigorous evidence, they often require navigating a complex political economy within the overall health system and its actors.

Practical methodology for coordinated procurement and distribution of essential medicines in Afghanistan, a complex donor-dependent country

Practical methodology for coordinated procurement and distribution of essential medicines in Afghanistan, a complex donor-dependent country

Inventory Policies for Public Pharmaceutical Distribution in Zambia: Improving Availability and Geographic Access Equity for Essential Medicines

Problem de finition: The inventory control problem associated with the distribution of essential medicines in Zambia involves seasonality and uncertainty in both demand and lead-times, heterogeneous delivery locations, and lost sales. Beyond the traditional performance metrics of system service level and inventory level, the equity of distribution across delivery locations must be considered. Academic/practical relevance: Stockouts of life-saving medicines are currently widespread in sub- Saharan Africa including Zambia. The companion study Leung et al. (2017) suggests that inventory management is an important opportunity, but ignores the challenge of distributing limited inventory to multiple locations. The existing literature on inventory management does not consider all aspects of this problem. Methodology: A simulation model generating inventory dynamics of anti-malaria products in 212 (17%) of Zambia's health facilities is used to compare the current and various proposed inventory policies. It leverages extensive data including digital photographs of facility stock reports and its stockout prediction accuracy is validated against independent field measurements. Results: Inventory control constitutes an important opportunity to improve patient access to medicines in Zambia. The policies proposed in USAID DELIVER (2011b) and Watson et al. (2014) perform well for only two of the three metrics of system service level, facility inventory and distribution equity, and are sensitive to their base stock parameter. Our proposed optimization-based policy outperforms these policies, and seems robust to policy parameters and demand forecasts accuracy. Managerial implications: The proposed optimization-based policy seems a desirable alternative to current inventory management practices and other proposed enhancements for Zambia's public pharmaceutical distribution system, and may outperform the so-called min/max rule in other settings. In distribution systems with heterogeneous delivery locations, widespread proportional inventory rationing rules may lead to substantial service level discrepancies between facilities. The performance metrics of average service level and distribution equity may be frequently at odds, prompting non-trivial design trade-o s and considerations.

Distribution of essential medicines to primary care institutions in Hubei of China: effects of centralized procurement arrangements

BackgroundPoor distribution of essential medicines to primary care institutions has attracted criticism since China adopted provincial centralized regional tendering and procurement systems. This study evaluated the impact of new procurement arrangements that limit the number of distributors at the county level in Hubei province, China.MethodsProcurement ordering and distribution data were collected from four counties that pioneered a new distribution arrangement (commencing September 2012) compared with six counties that continued the existing arrangement over the period from August 2011 to September 2013. The new arrangement allowed primary care institutions and/or suppliers to select a local distributor from a limited panel (from 3 to 5) of government nominated distributors. Difference-in-differences analyses were performed to assess the impact of the new arrangements on delivery and receipt of essential medicines.ResultsOverall, the new distribution arrangement has not improved distribution of essential medicines to primary care institutions. On the contrary, we found a 7.78–19.85 percentage point (p < 0.01) decrease in distribution rates to rural primary care institutions. Similar results were demonstrated using the indicator of received rates, with a 7.89–19.65 percentage point (p < 0.01) decrease.ConclusionsSimply limiting the number of distributors does not offer a solution to the poor performance of delivery of essential medicines for primary care institutions, especially those located in rural areas. Procurement arrangements need to consider the special characteristics of rural facilities. In a county, there are more rural primary care institutions than urban ones. On average, rural primary care institutions demand more and are more geographically dispersed compared to their urban counterparts, which may impose increased distribution costs.