Providing free medications increased adherence among patients and led to improvements in both their health outcomes and their perceptions of the quality of their care, according to a new study.
JAMA Internal Medicine on Monday released a study that examined medication adherence rates of more than 780 patients at primary-care sites throughout Ontario, Canada, from June 2016 through April 2017. Researchers compared adherence among those who received certain essential medicines for free with those who paid out of pocket for their medications.
While the study was conducted in a country that handles healthcare differently than the U.S., researchers say the findings could inform the current debate on healthcare reform and provide some best practices on what medications to use as well.
The drugs made available for free are among 128 treatments found on the World Health Organization's 2013 Model List of Essential Medicines, which includes antipsychotics, antiretrovirals, glucose-lowering medicines, and blood pressure medications as well as antibiotics.
According to the WHO, more than 150 countries use the list to guide decisionmaking on which medicines represent the best value for money.
The JAMA analysis found that 38% of patients who received free medications took them regularly compared with 26% of patients who had to pay for their drugs.
Not surprisingly, the study found improved adherence led to improved health outcomes, with those in the group that received free medications reporting bigger decreases in systolic blood pressure compared with the control group as well as indications that the diabetic patients who got free drugs were able to better control their disease.
Study co-author Dr. Navindra Persaud, a staff physician in the family and community medicine department at St. Michael's Hospital in Toronto, said providing free essential medications could help many low-income patients.
"The cost of medicines can be the difference between being able to make ends meet or to being able to afford food or not," Persaud said.
The findings also seem to indicate patients who received free medications were more likely to report their overall care improved and that they were able to afford other necessities. Pharmacists who participated in the study were given access to patients' electronic medical records, which in some cases identified potentially inappropriate prescriptions that were stopped before they reached the patient.
Persaud said having a short, universally recognized list of essential medicines could reduce counteractions, which the study found was less likely to occur among patients who got free access.
Global estimates of drug non-adherence range from 40% to 60% of prescriptions for chronic disease treatments. In the U.S., studies have estimated up to 30% of medication prescriptions are never filled and that as many as half of medications for chronic disease are not taken as prescribed.
Poor medication adherence is estimated to cost the country's healthcare system $100 billion to $289 billion annually, and causes approximately 10% of all hospitalizations and 125,000 deaths.
Of course, Canada's healthcare system provided an ideal setting for today's study since hospitalizations and physician care are funded by the government. Patients, however, are responsible for the cost of prescribed drugs.
Persaud hopes the study's findings inform the U.S. debate on how to reform the current health system.
"If you're creating a publicly funded healthcare system, you should design it with medications included," Persaud said.