Improving access to medicines for non-communicable diseases in rural primary care : results from a quasi-randomized cluster trial in a district in South India

Pati, Manoj Kumar; Bhojani, Upendra; Elias, Maya Annie; Srinivas, Prashanth N.

doi:10.1186/S12913-021-06800-X

Title

Improving access to medicines for non-communicable diseases in rural primary care : results from a quasi-randomized cluster trial in a district in South India

Author

Pati, Manoj Kumar

Bhojani, Upendra

Elias, Maya Annie

Srinivas, Prashanth N.

Abstract

Background: A large proportion of non-communicable diseases (NCDs) are treatable within primary health care (PHC) settings in a cost-effective manner. However, the utilization of PHCs for NCD care is comparatively low in India. The Access-to-Medicines (ATM) study examined whether (and how) interventions aimed at health service optimization alone or combined with community platform strengthening improve access to medicines at the primary health care level within the context of a local health system. Method: A quasi-randomized cluster trial was used to assess the effectiveness of the intervention (18 months) implemented across 39 rural PHCs (clusters) of three sub-districts of Tumkur in southern India. The intervention was allocated randomly in a 1:1:1 sequence across PHCs and consisted of three arms: Arm A with a package of interventions aimed at health service delivery optimization; B for strengthening community platforms in addition to A; and the control arm. Group allocation was not blinded to providers and those who assessed outcomes. A household survey was used to understand health-seeking behaviour, access and out-of-pocket expenditure (OOP) on key anti-diabetic and anti-hypertension medicines among patients; facility surveys were used to assess the availability of medicines at PHCs. Primary outcomes of the study are the mean number of days of availability of antidiabetic and antihypertensive medicines at PHCs, the mean number of patients obtaining medicines from PHC and OOP expenses. Result: The difference-in-difference estimate shows a statistically insignificant increase of 31.5 and 11.9 in mean days for diabetes and hypertension medicines availability respectively in the study arm A PHCs beyond the increase in the control arm. We further found that there was a statistically insignificant increase of 2.2 and 3.8 percentage points in the mean proportion of patients obtaining medicines from PHC in arm A and arm B respectively, beyond the increase in the control arm. Conclusion: There were improvements in NCD medicine availability across PHCs, the number of patients accessing PHCs and reduction in OOP expenditure among patients, across the study arms as compared to the control arm; however, these differences were not statistically significant.

Language

English

Source (journal)

BMC health services research. - London

Publication

London : 2021

ISSN

1472-6963

DOI

10.1186/S12913-021-06800-X

Volume/pages

21 :1 (2021) , 11 p.