Ακόμα κ στις χώρες που "δεν έχουν κανόνες στο εμπόριο", τα πράγματα δεν πάνε καλά. Στη Βρετανία, αναγκάστηκαν να πάρουν μέτρα, για να αποφύγουν τη φαρμακευτική κατάχρηση μέσα από τα eshop, στις δε ΗΠΑ, προσπαθούν να βρουν τρόπους να ενισχύσουν τα εξαντλημένα ιδιωτικά φαρμακεία, μιας κ ο ρόλος τους , στη θεραπεία των ασθενών κ μάλιστα των ηλικιωμένων, ειναι καθοριστικός. Το κέρμα έχει πάντα δύο πλευρές, κ όχι μια, όπως θέλουν κάποιοι πολιτικοί να παρουσιάσουν.
The researchers, led by UIC's Dima Qato, report that declines in adherence—including the complete discontinuation of medication—were highest among people using independent pharmacies, filling all their prescriptions at a single store, or living in low-access neighborhoods with fewer pharmacies.
The findings are published in JAMA Network Open.
"Although ongoing efforts to improve medication adherence focus on improving affordability, this study suggests that policies aimed at reducing non-adherence to prescription medications should also address system-level barriers beyond the high cost of prescription drugs, like pharmacy access," said Qato, associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy. "These findings provide strong evidence that pharmacy closures contribute to non-adherence, including among insured older adults."
Using information from a national all-payer pharmacy dispensing database that links patients across retail and non-retail channels, the researchers analyzed data collected from more than 3 million adults 50 years and older who filled at least one statin prescription at a retail pharmacy between 2011 and 2016. They compared medication adherence among people who had filled a prescription at a pharmacy that later closed—about 93,000 people—with adherence among people whose pharmacy remained open.
The researchers found that statin users in the closure cohort experienced "an immediate and significant decline in statin adherence" in the three months post-closure that was "largely due to the complete discontinuation of medication." Among statin users, about 23.8% of people in the pharmacy closure cohort did not refill their prescription at any point during the 12-month follow-up period, compared with only 12.8% in the non-closure cohort.
A decline in adherence also was observed among people who had been adherent to their prescription medications the year prior to the closure. Among those who were fully adherent at baseline, 15.3% in the closure cohort discontinued their statins, compared with only 3.5% in the non-closure cohort.
Qato and her colleagues observed similar trends for beta-blockers and anticoagulants.
Among those least likely to experience a decline in adherence were people who regularly used multiple retail stores.
"We found that declines in adherence were almost double among patients 'loyal' to a single store when compared to those using multiple stores," Qato said. She says this finding is important because retail pharmacies, particularly chains, often promote loyalty programs that encourage patients to fill all their prescriptions at one of their stores.
The authors recommend several strategies to prevent at-risk pharmacies from closing, including policies that ensure sufficient pharmacy reimbursement for prescription medications.
"Expanding regulations that require plans to meet convenient pharmacy access standards to also mandate minimum standards for reimbursement is a potential policy option," Qato said.
Strategies that directly target patients most at-risk for experiencing a pharmacy closure are also important to consider, the authors note. Potential strategies include pharmacy outreach to patients in advance of a planned closure, more flexibility from health plans on which pharmacies are preferred, and use of home-delivery by pharmacies and health plans to offset potential access barriers.
In addition, policies should consider the role of pharmacy benefit managers, or PBMs, the authors suggest.
"Pharmacy closures are expected to increase due to the expanding role of PBMs in the pharmacy market, largely as a result of an uptick in mergers and acquisitions. Therefore, failure to incorporate PBMs in efforts to improve access to prescription medications will likely worsen non-adherence among older adults in the U.S.," Qato said.
More information: Dima M. Qato et al, Association Between Pharmacy Closures and Adherence to Cardiovascular Medications Among Older US Adults, JAMA Network Open (2019). DOI: 10.1001/jamanetworkopen.2019.2606
Journal information: JAMA Network Open
Provided by University of Illinois at Chicago
New rules to keep people safe when buying medications from online pharmacies have been described as a "big step forward" by Britain's pharmacy regulator.
It comes after patients and relatives raised concerns, as well as an investigation by BBC Panorama.
The General Pharmaceutical Council has issued guidance for providers.
It will help regulate access to addictive medication, such as strong painkillers.
Duncan Rudkin, the General Pharmaceutical Council's chief executive, told the BBC that he hoped the new rules would "make an important difference to improving standards of safety and care for patients".8
Extra safety measures include:
- Sites cannot be set up in a way that allows patients to choose a prescription-only medication before an online consultation with a healthcare professional
- More safeguards will be introduced for certain medications, including antibiotics and medicines that need ongoing monitoring or management
- For medications that are liable to abuse, overuse or misuse, or when there is a risk of addiction, the prescriber needs to contact the GP in advance of issuing the prescription (and they have confirmed it is appropriate for the patient and the appropriate monitoring is in place)
- Online pharmacy websites should be clear about the identity and/or location of the pharmacies issuing prescriptions
Mr Rudkin said the Panorama programme "was really helpful in shining a light on a really important area of public safety".
It revealed how easy it was for patients to buy drugs online that their own GPs would be highly unlikely to prescribe.
Patients contacted Panorama after the programme.
Debbie Headspeath, 41, died in 2017 in Ipswich. Her brother, Kevin Duggan told the BBC that after her death, they found on bank statements that she had bought codeine from 18 online UK pharmacies.
Debbie had started a new job with war veterans and, despite waking up with stomach pains, she did not want to miss work.
"She put her jacket and bag on and then collapsed by the front door. She wasn't found until several hours later when her partner came home from work and it was too late and she had gone. She died."
Debbie had been prescribed the opiate-based painkiller dihydrocodeine by her family doctor in 2008 after developing back pain.
After several years, it was recognised she was addicted. The family doctor tried to wean her off, but she was able to secretly buy medication, prescribed by doctors and dispensed by UK pharmacies, without her GP being informed by the companies.
Kevin said: "There's no justification for what they do, which is exploiting people with an addiction. I would like to invite the companies to try and justify their actions to my mum.
"To look my mum in the eyes and explain why they allowed this to happen."
The inquest, which will decide the cause of death, is next month, but her brother told the BBC he felt the codeine had contributed to her death.
Son born addicted
Another relative of a patient contacted the BBC. His wife had developed back pain after the birth of their first child in 2014.
In 2016, he realised she was addicted to dihydrocodeine - the same drug prescribed to Debbie - and asked her GP to help her get off them.
In 2017, she found out she was pregnant again.
"I think when she fell pregnant she was taking 20 pills a day secretly.
"Then I think she realised, and then the midwife weaned her down to eight to 10 pills a day. And as a consequence of that, you know, my son was born addicted to opiates.
"To see your child in such distress, to see jerky movements; the shaking. It's something that I wouldn't want anybody to ever go through."
His wife managed to come off the codeine, but she has recently relapsed. He says that, so far, the medications have cost them nearly £25,000.
Mr Rudkin told the BBC: "I really want to acknowledge the pain that some families have experienced that's been associated in some cases with online pharmacies.
"It's really important that the stories help to change regulations. We've taken steps to address the risk."
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