Availability and accessibility of opioids for pain and palliative care in Colombia: a survey study
Abstract
Introduction: Access to essential medicines, including opioids, is a component of the right to health.
Objective: To identify barriers to opioid availability and accessibility for pain and palliative care.
Methods: Online survey with Colombian prescribers. Availability barriers were analyzed for each facility (distribution and/or dispensing). Accessibility barriers were analyzed by type. Descriptive analyses were conducted using relative frequencies. Significance within categories and regions was measured using Fisher's exact test.
Results: Out of 1,208 prescribers invited, 806 (66.7%) completed the survey. Availability: 76.43% reported barriers. The most cited barrier was “Pharmacies authorized by health insurance companies”, where opioids are frequently unavailable. Accessibility: 74.6% reported barriers. Most frequently cited was “Difficulty securing payment authorization for medication from health insurance companies”. Significant differences were observed in terms of regions and “Cost” (p=0.02). Lack of coordination among procuring and distributing agencies affects availability. Limited awareness and bureaucratic procedures affect accessibility.
Conclusions: There are barriers to opioid availability and access in Colombia, related to the existing structure for guaranteeing equitable supply. From the perspective of healthcare providers, problems related to pharmacy availability, prescription and cost of medicines hinder pain treatment.
References
World Health Organization (WHO). Integrating Palliative Care and Symptom relief into primary health care: A WHO guide for planners, implementers and managers. [Internet]. 2018. [Citado 2021 Oct 21]. Disponible en: https://apps.who.int/iris/handle/10665/274559
Indiana University. Walther Center in Global Palliative Care [Internet]. 2020. [Citado 2021 Oct 21]. Disponible en: https://painpolicy.iu.edu/opioid-consumption-data/regional/country/colombia.html
World Health Organization. WHO Model Lists of Essential Medicines [Internet]. 2019. [Citado 2021 Oct 21]. Disponible en: https://www.who.int/medicines/publications/essentialmedicines/en/
Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. The Lancet. 2018;391(10128):1391-454. doi: https://doi.org/10.1016/S0140-6736(17)32513-8
United Nations Office on Drugs and Crime (UNODC). World Drug Report 2020. [Internet]. 2020. [Citado 2021 Oct 21]. Disponible en: http://vngoc.org/wp-content/uploads/2020/07/wdr2020_Presentation-CSO_EN_27072020-rev.pdf
Observatorio Colombiano de Cuidados Paliativos. Reporte Técnico Observatorio Colombiano de Cuidados Paliativos 2016. [Internet]. 2016. [Citado 2021 Oct 21]. Disponible en: https://repositorio.unbosque.edu.co/handle/20.500.12495/6136
León Delgado MX, Sánchez-Cárdenas MA, Rodríguez-Campos L, De Lima L, Velasco AL, Gamboa-Garay OA, et al. Consumo de opioides: análisis de su disponibilidad y acceso en Colombia. Universidad de La Sabana; 2019. [Internet]. 2019. [Citado 2021 Oct 21]. Disponible en: https://intellectum.unisabana.edu.co/handle/10818/35826
Leon MX, De Lima L, Florez S, Torres M, Daza M, Mendoza L, et al. Improving availability of and access to opioids in Colombia: description and preliminary results of an action plan for the country. J Pain Symptom Manage. 2009;38(5):758-66. doi: https://doi.org/10.1016/j.jpainsymman.2009.03.007
Cleary JF, Maurer MA. Pain and Policy Studies Group: two decades of working to address regulatory barriers to improve opioid availability and accessibility around the world. J Pain Symptom Manage. 2018;55(2):S121-34. doi: https://doi.org/10.1016/j.jpainsymman.2017.03.029
Berterame S, Erthal J, Thomas J, Fellner S, Vosse B, Clare P, et al. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. The Lancet. 2016;16;387(10028):1644-56. doi: https://doi.org/10.1016/S0140-6736(16)00161-6
Leon M, Florez S, De Lima L, Ryan K. Integrating palliative care in public health: The Colombian experience following an International Pain Policy Fellowship. Palliative Medicine. 2011;25(4):365-9. doi: https://doi.org/10.1177/0269216310385369
Pastrana T, De Lima L, Wenk R. Estudio multicéntrico sobre la comodidad y el interés en cuidados paliativos en estudiantes de pregrado en Colombia. Medicina Paliativa. 2015;22(4):136-45. doi: https://doi.org/10.1016/j.medipa.2014.10.004
Pastrana T, Torres-Vigil I, De Lima L. Palliative care development in Latin America: an analysis using macro indicators. Palliative Medicine. 2014;28(10):1231-8. doi: https://doi.org/10.1177/0269216314538893
Sistema Único de Información Normativa del Congreso de la República de Colombia. Ley 1733 de 2014. [Internet]. 2014. [Citado 2021 Oct 21]. Disponible en: http://www.suin-juriscol.gov.co/viewDocument.asp?ruta=Leyes/1687420
Larjow E, Papavasiliou E, Payne S, Scholten W, Radbruch L. A systematic content analysis of policy barriers impeding access to opioid medication in Central and Eastern Europe: Results of ATOME. J Pain Symptom Manage. 2016;51(1):99-107. doi: https://doi.org/10.1016/j.jpainsymman.2015.08.012
García CA, Santos Garcia JB, Rosario Berenguel, Cook MD, Colimon F, Flores Cantisani JA, et al. Undertreatment of pain and low use of opioids in Latin America. Pain Manage. 2018;8(3):181-96. doi: https://doi.org/10.2217/pmt-2017-0043
Vargas-Peláez CM, Rover MR, Leite SN, Buenaventura FR, Farias MR. Right to health, essential medicines, and lawsuits for access to medicines–a scoping study. Social Science & Medicine. 2014;121:48-55. doi: https://doi.org/10.1016/j.socscimed.2014.08.042
Arias-Casais N, Garralda E, López-Fidalgo J, Rhee JY, Pons JJ, de Lima L, et al. Consensus building on health indicators to assess PC global development with an international group of experts. J Pain Symptom Manage. 2019;58(3):445-53. doi: https://doi.org/10.1016/j.jpainsymman.2019.04.024
Prada C, Chaves S. Health system structure and transformations in Colombia between 1990 and 2013: a socio-historical study. Critical Public Health. 2019;29(3):314-24. doi: https://doi.org/10.1080/09581596.2018.1449943
Vargas-Lorenzo I, Vázquez-Navarrete ML, Mogollón-Pérez AS. Acceso a la atención en salud en Colombia. Rev Salud Pública. 2010;12:701-12.
Nchako E, Bussell S, Nesbeth C, Odoh C. Barriers to the availability and accessibility of controlled medicines for chronic pain in Africa. International health. 2018;10(2):71-7. doi: https://doi.org/10.1093/inthealth/ihy002
Downloads
Article metrics | |
---|---|
Abstract views | |
Galley vies | |
PDF Views | |
HTML views | |
Other views |