Targeting Improved Access -- SEAM Conference 2001 -- Round Table Discussions

2001 SEAM Conference - Targeting Improved Access

Roundtable #2: Rational Drug Use and Pharmaceutical Care Initiatives

Moderator David Ofori-Adjei, Director, Noguchi Institute, University of Ghana

Resource persons Jorge Bermudez, Daniel Boesen, Anthony Savelli

Note takers Ned Heltzer, Marjorie Janvier (lead)

View the PowerPoint presentation online.
View the transcript of the presentation online.
Download the transcript of the presentation (PDF - 112KB).

Background and Issues

The quality of health care provided by both the public and private sectors and the quality of decisions made by consumers in relation to drug use and self-medication are critical elements that must be addressed in any initiative to improve access to and use of essential medicines. The need for improved quality was documented in the SEAM country assessments, where the appropriateness of drug prescribing and use was shown to be less than optimal. Rational use initiatives, including the potential application of pharmaceutical care and pharmacy benefits management (PBM) principles, will be important components of SEAM country programs.

Rational use, pharmaceutical care, and pharmacy benefits management initiatives encompass a range of organizational activities designed to influence the behavior of prescribers, dispensers, and other pharmaceutical service providers, as well as patients and consumers. The goal is to enhance access to and quality of pharmaceutical services, while impacting cost and use of medications. Specific strategies, among many others, that may be considered for SEAM country programs include accrediting health care providers, educating health care providers and patients/consumers, developing performance-based provider networks, creating new delivery models for underserved areas, and promoting community-based health insurance schemes.

As an example of a set of specific activities for one strategy-pharmacy network development-a country program might include-

Training and certification of "drug sellers"
Developing professional standards and best practice guidelines
Enforcing and controlling network standards
Providing business management resources for network participants
Branding and marketing this private sector network

To provide roundtable participants with some basic information on PBM initiatives, an article ("Pharmacy Benefit Management Companies: Dimensions of Performance") has been included with the Background Materials. Although this article provides useful information on definitions and the evolution of PBM initiatives have evolved in the United States, participants should understand that the information presented may not reflect the latest thinking and research related to PBM initiatives and their impact (e.g., the PBM business community would probably disagree with the article's statement that "questions concerning the impact of PBM companies on quality, costs, and patient outcomes remain unanswered"). The article also does not make the bridge between what the U.S. PBM experience has been and how PBM strategies can best be utilized in the developing country context. SEAM does not advocate the replication of the U.S. PBM model as part of SEAM country programs. We do think, however, that the PBM experience may identify innovative approaches to consider in creating programs to improve access to and use of essential medicines in developing countries.

Discussion Points

Can pharmaceutical care and pharmacy benefits management principles and strategies be appropriately applied in developing country situations to enhance the quality of pharmaceutical services delivery and promote appropriate drug use? What strategies might work best?
What are the roles and potential contributions of medical and pharmacy performance-based provider networks? Community-based health insurance schemes?
What is the appropriate role of "drug sellers" in a pharmaceuticals distribution network? Should they be trained and certified to provide basic health care services? Is it possible to use standard treatment guidelines (STGs) with well-defined decision trees to assist in the proper selection of drug therapy?
Should strict professional standards and best practice guidelines for network participants be instituted? If so, is it appropriate for network marketing efforts to "advertise" the advantages offered over the average pharmacy in product quality assurance, certified drug sellers, etc.?
What incentives can be considered in order to encourage voluntary network participation? PBM programs secure participation by controlling access to third-party-payer programs. When third-party payers are nonexistent or few, what other incentives might be employed to develop these performance-based networks?
If network management resources were available to provide both health care and business related training, should they be used to assist current businesses to expand into underserved areas? If so, how should we choose which network participant to support when more than one express an interest? Should this support include financial assistance?

Background Materials

Lipton, Helene L., et al. 1999. Pharmacy Benefit Management Companies: Dimensions of Performance. Annu. Rev. Public Health. 20: 361-401.

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