Impact of Free Essential Medicines on Treatment Adherence in Canada
Overview of Nonadherence Issues
Canadian healthcare policy experts have examined how providing free essential medicines may influence treatment adherence among patients. Many individuals struggle to access medications for common health conditions such as heart disease and diabetes due to high costs. Globally, nonadherence to drug treatments for chronic diseases is estimated to be between 40% and 60%.
WHO Recommendations and Canadian Context
To enhance access to care and work towards universal health coverage, the World Health Organization (WHO) advises countries to create a list of essential medicines tailored to their healthcare needs. In Canada, while physician services and hospitals are publicly funded, outpatient medications are not uniformly covered. Funding for medications varies by province, often limited to specific populations like those receiving social assistance or seniors over the age of 65.
Research Study and Methodology
A team of health policy experts in Canada investigated the impact of free essential medicines on treatment adherence. They also conducted in-depth interviews with policy decision-makers to evaluate the possibility of establishing a national essential medicines list. Their findings were recently published in *JAMA Internal Medicine* and the *Canadian Medical Association Journal*.
Findings on Treatment Adherence
The researchers compiled a list of 128 essential medicines, drawing from the WHO Model List and Canadian clinical practice guidelines, as well as recommendations from healthcare professionals and patients. This list included antibiotics, pain relievers, antihypertensives, diabetes medications, lipid-lowering agents, antipsychotics, and medications for HIV/AIDS.
The study involved 786 patients from nine primary care clinics in Ontario, who reported nonadherence to medications due to cost. These patients were randomly assigned to either receive free essential medicines (intervention group) or maintain their usual access to medications (control group).
After 12 months in a three-year study, adherence rates were higher in the intervention group at 38.2%, compared to 26.6% in the control group, reflecting an 11.6% difference. Additionally, some health markers improved in the intervention group, including blood sugar control in diabetes patients and blood pressure control in those with hypertension. However, improvements in blood lipid levels were not statistically significant.
Perspectives from Policy Decision-Makers
Structured interviews with key policy decision-makers revealed consensus on three critical factors for developing an essential medicines list: the need for an independent decision-making body, selecting medicines based on robust clinical evidence, and ensuring clear communication among patients, healthcare providers, and policymakers regarding the list’s purpose.
Conclusions and Future Implications
The researchers concluded that free essential medicines could significantly enhance treatment adherence after 12 months. While some disease-specific markers improved, others did not show significant changes. Despite differing opinions among decision-makers regarding the feasibility of an essential medicines list in Canada, there was general agreement on how to proceed with its development.
“It is sad that in a high-income country like Canada, millions of Canadians cannot afford their prescribed medications – including life-saving medicines such as insulin,” stated Dr. Nav Persaud, the study’s lead author. The researchers aim for their findings to influence policy changes, emphasizing that the question now is not whether free distribution of medicines can improve health outcomes, but whether governments will take action. Following this study, the Canadian Federal Advisory Council on the Implementation of National Pharmacare recommended universal public pharmacare to cover a list of essential medicines.
References
Persaud N, Bedard M, Boozary AS, et al. Effect on treatment adherence of distributing essential medicines at no charge. JAMA Intern Med Published online Oct 7, 2019. Doi:10.1001/jamainternmed.2019.4472
Jarvis J, Murphy A, Perel P, et al. Acceptability and feasibility of a national essential medicines list in Canada: a qualitative study of perceptions of decision-makers and policy stakeholders. CMAJ 2019 October 7;191:E1093-9. Doi:10.1503/cmaj.190567.
St Michael’s Hospital, Press release, 7 Oct 2019. “Distributing essential medicines for free resulted in a 44% increase in adherence.” https://www.eurekalert.org/pub_releases/2019-10/smh-dem100319.php
Canadian Medical Association Journal, Press release, 7 Oct 2019. “A Canadian essential medicine list must be evidence-based.” https://www.eurekalert.org/pub_releases/2019-10/cmaj-ace100319.php