Providing Free Meds Ups Adherence, Not All Outcomes

Nicola M. Parry, DVM

October 07, 2019

Providing essential medicines at no charge increased patients' adherence to their prescribed treatment, a study published online October 7 in JAMA Internal Medicine has shown.

It also "improved some, but not other, disease-specific surrogate health outcomes," write Navindra Persaud, MD, St. Michael's Hospital, Toronto, Ontario, Canada, and colleagues.

Cost is a significant barrier to medication adherence that prevents many patients worldwide from accessing their life-saving medications.

With this in mind, Persaud and colleagues conducted a study at nine primary care sites in Ontario, Canada, to investigate whether distributing essential medicines free of charge to primary care patients who were unable to afford medicines might improve treatment adherence.

"Canada is a suitable setting to measure the effects of medicine distribution because physician care and hospitalizations are universally publicly funded, while medicines are not," the authors say.

In the randomized clinical trial, 764 adults (aged ≥ 18 years) were enrolled who had reported treatment nonadherence because of not being able to afford their medications.

Patients were randomly assigned to receive free essential medicines plus usual care (n = 395) or usual access to medicines plus usual care (n = 391).

The medicines used in the trial included some for acute conditions (such as antibiotics and analgesics) and some for chronic conditions (such as antipsychotics, antiretrovirals, glucose-lowering medicines, and antihypertensives).

After 1 year, more patients receiving free medicines were adherent to treatment than those with usual access to medicines (38.2% vs 26.6%; difference, 11.6%; 95% CI, 4.9% - 18.4%; P < .001).

However, only some measures of patients' health outcomes had improved.

Access to free medicines improved systolic blood pressure (−7.2 mmHg; 95% CI, −11.7 to −2.8 mmHg; P = .002) in patients receiving antihypertensives but did not significantly improve low-density lipoprotein cholesterol levels (−2.3 mg/dL; 95% CI, −14.7 to 10.0 mg/dL; P = .70) in patients receiving statins. Although A1c levels (−0.38%; 95% CI, −0.76% to 0.00%; P = .05) improved in patients with type 1 or 2 diabetes, the results did not reach statistical significance.

Researchers found no significant difference in serious adverse events between the two groups.

In discussing their study, Persaud and colleagues highlight the need for caution in applying the results to other regions with different healthcare services and disease burdens.

Nevertheless, they emphasize that the findings could help guide changes to medicine access policies such as publicly funding essential medicines.

The study was supported by the Canadian Institutes for Health Research (CIHR), Ontario SPOR Support Unit (supported by the CIHR and Province of Ontario), Canada Research Chairs program, and St Michael's Hospital Foundation. Several authors have reported relationships with the Ontario Ministry of Health and Long-Term Care, AstraZeneca, Biotronik, Biosensors International, Eli Lilly, and The Medicines Company. A complete list of disclosures is available on the journal website.

JAMA Intern Med. Published online October 7, 2019. Abstract

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