ABSTRACT
BACKGROUND: Direct out-of-pocket payments (OOP) are among the most important financing mechanisms in many health systems, especially in developing countries, adversely affecting equality and leading vulnerable groups to poverty. Therefore, this scoping review study was conducted to identify the strategies involving OOP reduction in health systems. METHODS: Articles published in English on strategies related to out-of-pocket payments were Searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between January 2000 and November 2020, following PRISMA guidelines. As a result, 3710 papers were retrieved initially, and 40 were selected for full-text assessment. RESULTS: Out of 40 papers included, 22 (55%) and 18 (45%) of the study were conducted in developing and developed countries, respectively. The strategies were divided into four categories based on health system functions: health system stewardship, creating resources, health financing mechanisms, and delivering health services.As well, developing and developed countries applied different types of strategies to reduce OOP. CONCLUSION: The present review identified some strategies that affect the OOP payments According to the health system functions framework. Considering the importance of stewardship, creating resources, the health financing mechanisms, and delivering health services in reducing OOP, this study could help policymakers make better decisions for reducing OOP expenditures.
ABSTRACT
BACKGROUND: Medication adherence is an important concept particularly among the elderly that can, directly and indirectly, affect the health system's costs and the elderly's health, quality of life, and functional abilities. This study aimed to determine the model of medication adherence among the Iranian elderly using the grounded theory approach. METHODS: The concept of medication adherence and the determination of its process among the elderly is a multidisciplinary social issue that can be affected by many contextual factors. Grounded theory with the approach of Strauss and Corbin (2004) was applied to determine the customized model. Data triangulation occurred through semi-structured interviews, observation, field notes, and memoing. Open coding, selective coding, and axial coding were applied to analyze the data. RESULTS: Delinquency in the medication use among the elderly was caused by factors such as doubtfulness, fear of complications, not following the patients by the physicians, and negative others and medical staff's impacts. During the process of medication adherence, the patient's lack of knowledge, lack of sufficient education, inappropriate and restricted lifestyle, difficult living conditions, and social pressures imposed on individuals could exacerbate and worsen the delinquency in medication adherence. It should not be neglected that some other factors such as lack of an effective supervision system, lack of supportive organizations, stakeholders' market-based behaviors, consumption inconvenience, consumption stress, hopelessness, and misunderstanding could also aggravate the delinquency. CONCLUSIONS: Although the proposed theory and model were customized and context-based for the Iranian elderly, in general, making positive changes in the process of adherence to the medication use among the elderly requires scientific and basic management and planning of its factors. It should be noted that making these changes requires some interventions in and cooperation of all levels of the country's health system, from the Ministry of Health and Medical Education to the individual level of the elderly.
ABSTRACT
OBJECTIVE: Due to high rates of irrational use of medicines and low rates of medication adherence among older Iranian patients, this study aimed to explore the determinants of medication adherence in the elderly. METHODS: This qualitative study was conducted in 2019 via 20 semi-structured interviews with a purposeful sample of elderly people and health-care personnel. Transcript data were analyzed applying thematic analysis. MAXQDA10 was used for thematic analysis and presenting a thematic map. RESULTS: Two main themes appeared as the main determinants of medication adherence: individual determinants and external determinants. Other results show that there were six sub-themes and 23 main categories in this regard. The sub-themes were as follows: consumption disorder, consumption acceptance, delinquency, forgetfulness, sociocultural factors, and others' impacts. CONCLUSIONS: Different individual and external factors can affect elderly people's medication adherence. Considering the significance of this issue for the health of elderly people and the whole community, positive changes are needed to manage the medication-adherence process. Basic and scientific planning, appropriate interventions, and comprehensive collaboration among all health-system levels are required for implementing such changes.
