Policy change and regulation of primary care prescribing and dispensing in Macedonia : a qualitative study

• Main Author: Milevska Kostova, Neda
• Other Authors: Cooper, Richard ; Cooper, Katy
• Published: University of Sheffield 2017
• Subjects: 610
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.733623

Background. Former socialist countries’ transitions to market economies have had significant implications for health service policy and delivery. This study uses the transition in Macedonia as a case study setting to explore how such changes and related policies have been perceived to impact upon an important area, the prescribing and supply of medicines. This study focuses on the key primary care policies relating to limitations to prescribing volume and dispensing policy enforcement. Study aims were to explore experiences and perceptions of how privatisation and regulation policies influenced the prescribing and dispensing of medicines from the perspectives of primary care physicians, pharmacists, patients and elite group stakeholders. Methods. A qualitative design was used utilising semi-structured interviews with a purposive and snowball sample of 17 doctors, 12 pharmacists, 14 patients and 13 elites. Interviews were conducted face-to-face and fully recorded and transcribed and then analysed using a thematic analysis approach. Findings. Differing but often negative perspectives emerged, with primary care provider physicians and pharmacists feeling pressure from both regulatory and governmental bodies and patients qua their expectations and medicines demands. Physicians and pharmacists felt detached from policies and that guidance was lacking. Disempowerment and threats to professional autonomy resulted, with unethical implications for irrational prescribing and supplying medicines without prescriptions. Elites considered recent policy changes as necessary although they, and other participants, made comparisons to the previous system which was viewed with nostalgia, as being fairer. Mandatory prescription enforcement appeared ineffective with patients being able to obtain medicines, although patients reported new pressures in negotiating medicine supply and justifying self-medication practices. Lack of coherent policy implementation was a recurring theme. Discussion and Conclusions. Increasing regulation, marginalised professionals and patients led to numerous negative experiences. Using a Habermasian perspective, policy changes within Macedonia reflect a system that threatens individuals' lifeworlds; new policies represent juridification and professionals’ perception of being isolated, uninvolved and unsupported, reflecting disruption of communicative acts and justice. This study suggests the need to improve communication between different stakeholders and involve practitioners and patients to ensure policy change is sensitive, and not a threat, to individuals' autonomy.