Collao-Vasquez, Juan Francisco; (2011) Access to medicines in Chilean public hospitals: Building access to more innovative medicines. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Access to medicines is a problem of serious implication for the poorest countries in the world. Although in a different dimension, deficient access to innovative medicines is also present in medium and high income countries. Unlike most of the essential medicines, innovative medicines are technologies for which information on its effectiveness and safety is still very limited. The selection and use of more innovative and often more expensive drugs, is always made under limited budgets, making the selection of those medicines a challenge for health systems. In this perspective, the WHO recommends the use of multidisciplinary committees which decides the inclusion of medicines in the formulary based in the best available evidence, increasing the rationality of those decisions. Despite the widespread use of those committees in high income countries, little information is available about the use of such committees in medium income countries were resources are more scarce. Aims: To investigate how decisions are made to include a drug in the clinical practice of Chilean Public hospitals To identify factors that could influence access to medicines in Chilean public hospitals Methods: A mixture of quantitative and qualitative methods were used, a nationwide postal survey, and a qualitative research were performed. The qualitative study included focus groups, in-deep semi structured interviews, field observations and document research. Results: Despite most of the hospitals reporting having a committee, this committee seemed to lack power to influence prescribing in the visited hospitals. The weakness of the committee combined with a very limited budget for medicines stop public hospitals to be more innovative. Innovation in those hospitals is left to individual clinicians who innovate by requesting special purchase of medicines. Discussions: This exploratory study made available for the first time, information about Chilean public hospitals. The findings of the study improved our understanding of factors stopping hospitals from being more innovative in the use of medicines in Chile. Furthermore, this study gives valuable information to policy makers, and setting the basis to further research in Chile. In addition, the implications of this research can help other medium income countries to make a rational transition from the provision of essential pharmacotherapy to the use of more innovative medicines.

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