背景:已建议采用多标准决策分析(MCDA)方法,以帮助低收入和中等收入国家的购买者对多来源药品进行基于证据的评估,以减轻基于价格的决定对患者获得有效药物的潜在不利后果。在印度尼西亚举办了六次开发MCDA采购工具的讲习班,哈萨克斯坦,泰国,2017-2020年科威特。在印度尼西亚和泰国,两项试点举措旨在实施医院药品采购决策工具。
目的:通过分析和比较MCDA研讨会的经验和进展以及印度尼西亚和泰国的两个医院实施案例,我们的目标是获得洞察力,这将支持未来的实施。
方法:在所有四个国家和地区开发的MCDA仪器中,对标准的选择及其平均重量进行了定量比较。研究了两个案例的实施经验,其中包括(1)在泰国的七家医院中对各种药物进行测试,以及(2)在印度尼西亚的一家专科医院中实施。在泰国和印度尼西亚的试点实施项目中,通过网络会议与四个不同的利益攸关方进行了半结构化访谈。通过定性内容分析和使用扎根理论编码的综合来评估开放响应。
结果:实施的驱动因素正在做出“更好”的决定,实现透明度和合理的选择过程,减少药物短缺,并确保一致的质量。在技术层面上看到了挑战(定义或标准,评分方法,访问数据)或与变化相关的挑战(阻力、对工作量增加的看法,缺乏能力或能力,缺乏资源)。MCDA仪器的比较显示出很高的相似性,但也明确需要在每个特定情况下进行本地调整。
结论:一系列针对与公用事业相关的挑战的措施,方法论,数据要求,能力建设和培训以及更广泛的社会影响可以帮助克服实施中的挑战。建议对实施和组织变革进行仔细规划,以确保承诺并适应当地环境和文化。为基于MCDA的采购的每个应用设计协作变革计划,将使医疗保健利益相关者能够在护理的质量和有效性以及患者的获取方面最大程度地受益。
BACKGROUND: A multi-criteria decision analysis (MCDA) approach has been suggested for helping purchasers in low- and middle-income countries in an evidence-based assessment of multi-source pharmaceuticals to mitigate potential adverse consequences of price-based decisions on patient access to effective medicines. Six workshops for developing MCDA-instruments for purchasing were conducted in Indonesia, Kazakhstan, Thailand, and Kuwait in 2017-2020. In Indonesia and Thailand, two pilot-initiatives aimed to implement the instruments for hospital drug purchasing decisions.
OBJECTIVE: By analysing and comparing the experiences and progress from the MCDA-workshops and the two case-examples for hospital implementation in Indonesia and Thailand, we aim to gain insights, which will support future implementation.
METHODS: The selection of criteria and their average weight were compared quantitatively across the MCDA-instruments developed in all four countries and settings. Implementation experiences from two case-examples were studied, which included (1) testing the instrument across a variety of drugs in seven hospitals in Thailand and (2) implementation in one specialty hospital in Indonesia. Semi-structured interviews were conducted via web-conferences with four diverse stakeholders in the pilot implementation projects in Thailand and Indonesia. The open responses were evaluated through qualitative content analysis and synthesis using grounded theory coding.
RESULTS: Drivers for implementation were making \'better\' decisions, achieving transparency and a rational selection process, reducing drug shortages, and assuring consistent quality. Challenges were seen on the technical level (definition or of criteria, scoring methods, access to data) or change-related challenges (resistance, perception of increased workload, lack of competencies or capabilities, lack of resources). The comparison of the MCDA instruments revealed high similarity, but also clear need for local adaptations in each specific case.
CONCLUSIONS: A set a of measures targeting challenges related to utility, methodology, data requirements, capacity building and training as well as the broader societal impact can help to overcome challenges in the implementation. Careful planning of implementation and organizational change is recommended for ensuring commitment and fit to local context and culture. Designing a collaborative change program for each application of MCDA-based purchasing will enable healthcare stakeholders to maximally benefit in terms of quality and effectiveness of care and access for patients.