Does access to medicines differ from access to healthcare? Experiences of barriers to medicines access by people facing social disadvantage.

Abstract

Background: Levesque et al.'s widely-cited five dimensional model of access to healthcare has been used in a variety of contexts, including access to medicines. However the model is based on healthcare, i.e., facilities where health professionals work. We examined whether there were other important features of access to medicines, not captured by this model.

Methods: A longitudinal qualitative study was conducted, repeatedly interviewing 21 households about their lives and access to medicines, over the course of a year. Participants were Māori, Pacific, former refugee, or New Zealand Europeans with limited incomes. Analysis was thematic and inductive.

Results: Our participants experienced a number of barriers to accessing medicine, some of which do not fit comfortably within existing models of access to healthcare. For example, communication difficulties with healthcare staff (lack of appropriateness of care), had implications for medicine-taking after participants got home. Confusion about medicines identity, purpose and possible side effects, led to poorer access or under-use of prescribed medicines. Communication problems were particularly acute for former refugee participants. For them, communication in pharmacies was impossible because of lack of interpreters, severely restricting the information they had access to, and increasing the use of other less reliable sources of information. Crime, fear of crime, and the justice system also impacted on access in a variety of ways.

Conclusion: Because medicines are portable, physical objects taken at home, the effects of appropriateness of healthcare are played out in the home. Aspects of the wider, non-healthcare environment also impact on access to medicines in unexpected ways.