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      The Impact of the Sanctions Made Against Iran on Availability to Asthma Medicines in Tehran

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          Abstract

          The impact of the international sanctions on the Central Bank of Iran in 2013 and also accessibility of medicines in this country have received a lot of media coverage. In this study we used the data collected from a group of pharmacies all located in Tehran to assess the potential effects of the banking sanctions on access to asthma medicines. Data were collected from forty community pharmacies in Tehran, using a standard methodology proposed by the WHO and Health Action International. Data were collected in two stages: first before the sanctions were made against the banking system in the summer of 2012, and second after they were in effect in the summer of 2013, and they were analyzed using univariate analysis techniques. Several imported medicines were already in shortage during 2012. As a result of the sanctions, the availability of both imported and locally manufactured asthma medicines decreased by 19% and 42%, respectively. While before the height of the sanctions 60% of the pharmacies could provide all the essential asthma medicines, this number reduced to 28% after the sanctions (p-value: 0.003). While studies about “access to medicines” in Iran prior to 2011 were indicating appropriate access, our findings suggested that the availability of asthma medicines in community pharmacies was already less than ideal in 2012 and declined dramatically after the latest wave of the sanctions. Our findings show the important effects of the sanctions on availability of asthma medications in community pharmacies.

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          The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries.

          To assess the availability and affordability of medicines used to treat cardiovascular disease, diabetes, chronic respiratory disease and glaucoma and to provide palliative cancer care in six low- and middle-income countries. A survey of the availability and price of 32 medicines was conducted in a representative sample of public and private medicine outlets in four geographically defined areas in Bangladesh, Brazil, Malawi, Nepal, Pakistan and Sri Lanka. We analysed the percentage of these medicines available, the median price versus the international reference price (expressed as the median price ratio) and affordability in terms of the number of days wages it would cost the lowest-paid government worker to purchase one month of treatment. In all countries
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            Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries

            OBJECTIVE: To investigate potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries. METHODS: Data on the availability of 30 commonly-surveyed medicines - 15 for acute and 15 for chronic conditions - were obtained from facility-based surveys conducted in 40 developing countries. Results were aggregated by World Bank country income group and World Health Organization region. FINDINGS: The availability of medicines for both acute and chronic conditions was suboptimal across countries, particularly in the public sector. Generic medicines for chronic conditions were significantly less available than generic medicines for acute conditions in both the public sector (36.0% availability versus 53.5%; P=0.001) and the private sector (54.7% versus 66.2%; P=0.007). Antiasthmatics, antiepileptics and antidepressants, followed by antihypertensives, were the drivers of the observed differences. An inverse association was found between country income level and the availability gap between groups of medicines, particularly in the public sector. In low- and lower-middle income countries, drugs for acute conditions were 33.9% and 12.9% more available, respectively, in the public sector than medicines for chronic conditions. Differences in availability were smaller in the private sector than in the public sector in all country income groups. CONCLUSION: Current disease patterns do not explain the significant gaps observed in the availability of medicines for chronic and acute conditions. Measures are needed to better respond to the epidemiological transition towards chronic conditions in developing countries alongside current efforts to scale up treatment for communicable diseases.
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              Factors associated with hospital admissions and repeat emergency department visits for adults with asthma.

              A small proportion of patients with asthma account for a disproportionate number of acute health service events. To identify whether factors other than severity and low socioeconomic status were associated with this disproportionate use, a prospective study was undertaken to examine management and psychosocial factors associated with increased risk for admission to hospital with asthma and repeat visits to the emergency department over a 12 month period. A total of 293 patients with moderate or severe asthma managed at least in part at two teaching hospitals completed surveys of clinical status, acute events, sociodemographic, and psychological variables. Twenty three percent had a single admission to hospital and 16% had two or more hospital admissions. Twenty six percent had one emergency department visit and 32% had two or more visits to the emergency department. In a multiple logistic regression model, adjusted for age, sex, education and income, odds ratios (95% CI) for baseline factors associated with hospital admissions over the next 12 months were: moderate severity compared with severe asthma 0.6 (0.2 to 0.9); no hospital admissions in the past 12 months 0.1 (0.01 to 0.2); not possessing a written asthma action plan 4.0 (1.5 to 10.7); less use of an avoidance coping style 0.4 (0.3 to 0.7); lower preferences for autonomy in asthma management decisions 1.4 (0.96 to 2.0). Adjusted odds ratios (95% CI) for repeat emergency department visits were: moderate asthma severity 0.3 (0.1 to 0.8); current regular use of oral corticosteroids 10.0 (3.1 to 32.4); a hospital admission in the past 12 months 2.9 (1.8 to 4.8); not possessing a written asthma action plan 2.2 (1.1 to 5.6); less dislike of asthma medications 0.7 (0.5 to 0.9). In addition to factors relating to severity, not possessing a written asthma action plan, avoidance coping, and attitudes to self-management were related to acute use of health services in this at risk group. Interventions need to address or take these factors into account to reduce asthma morbidity.
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                Author and article information

                Journal
                Iran J Pharm Res
                Iran J Pharm Res
                IJPR
                Iranian Journal of Pharmaceutical Research : IJPR
                Shaheed Beheshti University of Medical Sciences (Tehran, Iran )
                1735-0328
                1726-6890
                Summer 2016
                : 15
                : 3
                : 567-571
                Affiliations
                [a ] Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
                [b ] Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences.
                [c ] Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [d ] Department of Pharmacoeconomics and Pharmaceutical Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
                Author notes
                [* ]Corresponding author: E-mail: arash.rashidian@gmail.com
                Article
                ijpr-15-567
                5149045
                27980593
                4774bf25-b596-48f1-a681-88daf79c854e
                © 2016 by School of Pharmacy , Shaheed Beheshti University of Medical Sciences and Health Services

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : November 2014
                : February 2015
                Categories
                Original Article

                sanction,availability,asthma medicines,pharmacies
                sanction, availability, asthma medicines, pharmacies

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