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Zeitouny, Seraphine

University of British Columbia

The research presented in this dissertation focused on three key dimensions in access to medicines in Canada and internationally, including medication adherence, use, and availability. Using rigorous observational study designs and the analysis of large clinical and administrative databases, access to medicines was assessed through three complementary studies. Study I revealed the prevalence of primary non-adherence (PNA) in primary care and suggested that 17% of new prescriptions remained unfilled in British Columbia, Canada. While PNA rates were higher for drugs prescribed mostly on an as-needed basis, they were prevalent across common medications for chronic conditions. Female providers, older providers, younger patients, and using multiple medications were all associated with higher odds of PNA. Patients filled over 82% of their new medication prescriptions within two weeks of their primary care provider visit. These findings could support the development of appropriate interventions aimed at improving primary adherence. Study II was a population-based study that uncovered empirical changes in prescription drug use, both overall and by drug classes, following the declaration of the COVID-19 pandemic and related mitigation measures in British Columbia, Canada. After an initial drop in prescription drug dispensing, prescribing trends remained constant or reversed towards pre-pandemic levels for major therapeutic categories and drug classes. However, sharp declines were observed in outpatient antimicrobial dispensing contrasted with sustained incremental increases in nervous system drug dispensing during the first year of the pandemic. These findings demonstrated the utility of monitoring drug dispensing trends to identify tracer conditions and forecast future medication needs. Moving into an international context, Study III was a time-series cross-sectional study that unravelled trend changes in vaccine sales in 84 countries following the COVID-19-induced disruptions to pharmaceutical supply chains and demand uncertainty. This study revealed the heterogeneous impact of COVID-19 on vaccine sales across country-income groups, with a relative increase in the per-capita vaccine sales in lower-middle-income countries (LMICs) as opposed to a decrease in high-income countries (HICs). Nevertheless, it underlined the consistent disparities in per capita vaccine sales that remained over four times higher in HICs than in LMICs and called for action to ensure equitable distribution of vaccines.

Text

2024-03-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/82757

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/