By: Leslie Shepherd
Researchers at St. Michael’s Hospital have developed a list of 125 essential medicines they say the federal government should provide free to all Canadians who need them.
The list is based on the longer World Health Organization Model List of Essential Medications and covers most medications now prescribed by primary care providers in Canada.
Dr. Nav Persaud, a family physician at St. Michael’s Hospital who led the project, said the large number of medications available in Canada poses a challenge for clinicians. The Ontario Drug Benefit formulary – the official list of medications that may be prescribed – lists more than 3,000 medications.
“A short list of essential medications might make it easier for clinicians to prescribe the most effective, safe and appropriate medications for their patients,” Dr. Persaud said.
An explanation of how and why the 125 medications were chosen was published today in the online, open access journal CMAJ Open. A companion paper published in the Canadian Medical Association Journal found that publicly funding 117 of those medications to for all Canadians could address most of Canadians’ pharmaceutical needs and save $3 billion a year.
Dr. Persaud notes that about one in 10 Canadians cannot afford prescribed medicines and more than one in five Canadians report that they or someone in their household had skipped doses, split pills or not filled their prescriptions to save money.
He said an essential medicine list could also serve as a national formulary or assist in the development of one, as many studies have recommended.
To develop the Canadian list, Dr. Persaud and his colleagues, as well as other Canadian clinicians, reviewed the 448 medications on the WHO list. Items were taken off the WHO list if:
– they weren’t drugs (e.g. condoms)
– the medications had the same uses as other listed medications
– they medications were used for conditions uncommon in Canada (e.g. an anti-parasitic drug)
– they were cancer treatments and other drugs that are administered in hospital
The researchers also added drugs not on the WHO list but based on Canadian clinical practice guidelines such as alendronate, which is used to treat and prevent osteoporosis.
The researchers also did prescription audits of two Toronto Family Health Teams to identify common prescriptions that were not on the list. They found the list covered 91 and 93 per cent of prescriptions at the inner city and suburban clinics respectively. In addition, 93 per cent of the patients seen at the inner city clinic and 96 per cent of the patients seen at the suburban clinic had all or all but one of their medications covered by the list.
Dr. Persaud is leading a clinical trial with patients in four Family Health Teams in Ontario to compare the health outcomes and health-care use of people who received the free essential medicines and those who did not. The trial is funded through the Ontario Strategy for Patient-Oriented Research Support Unit and the St. Michael’s Hospital Foundation.
This paper is an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
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Manager, Media Strategy, St. Michael’s Hospital