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Barriers to accessing biologic treatment for rheumatoid arthritis in Greece: the unseen impact of the fiscal crisis—the Health Outcomes Patient Environment (HOPE) study

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Abstract

The latest regulatory change in the distribution system of biologic disease-modifying, antirheumatic drugs limited their sale only through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (NHS) hospitals, adding to the complexity of access to effective treatment for rheumatoid arthritis (RA) in Greece. The aim of this paper was to assess the barriers to access RA treatment, by recording patients’, rheumatologists’ and EOPYY pharmacists’ experiences. One twenty-three patients, 12 rheumatologists and 27 pharmacists from Athens and other urban areas in Greece participated in the study. Three types of standardized questionnaires were used to elicit information from each group of respondents using the method of personal interview for patients and the method of postal survey for doctors and pharmacists. During the last year, 26 % of patients encountered problems in accessing their rheumatologist and 49 % of patients experienced difficulties in accessing their medication. Ninety-two percent of rheumatologists and 96 % of pharmacists confirmed that patients experience difficulties in accessing RA medication. The most commonly reported reasons for reduced access to medical treatment were travel difficulties and long distance from doctor’s clinic, as well as delays in booking an appointment. The most frequently reported barriers to access pharmaceutical treatment were difficulties in the prescription process, distance from EOPYY pharmacies and medicine shortages in NHS hospitals. The study showed that RA patients are facing increased barriers to access timely and effective treatment. Redesign of the current system of distribution ensuring the operation of additional points of sale is deemed necessary.

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Notes

  1. These include (a) presence of RF and/or anti-CCP antibodies (particularly at high titers), (b) erosions in hands and/or feet detected by radiographs and (c) high disease activity (according to Disease Activity Index, number of swollen joints or the presence of acute-phase proteins).

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Acknowledgments

The authors would like to thank Vassiliki Alexiou, Eleni Alexopoulou, Stamo Georgala and Aikaterini Pournaropoulou for their valuable assistance in collecting the data for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Health Policy, Faculty of Social Sciences, University of Peloponnese, Corinth, Greece

    Kyriakos Souliotis

  2. Centre for Health Services Research, Medical School, University of Athens, Athens, Greece

    Kyriakos Souliotis & Manto Papageorgiou

  3. National Organization for Healthcare Services Provision, Athens, Greece

    Anastasia Politi

  4. Rheumatology Department, General Hospital of Athens ‘G. Gennimatas’, Athens, Greece

    Dimitrios Ioakeimidis

  5. Department of Rheumatology, Medical School, University of Crete, Crete, Greece

    Prodromos Sidiropoulos

Authors
  1. Kyriakos Souliotis
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  2. Manto Papageorgiou
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  3. Anastasia Politi
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  4. Dimitrios Ioakeimidis
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  5. Prodromos Sidiropoulos
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Correspondence to Kyriakos Souliotis.

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Souliotis, K., Papageorgiou, M., Politi, A. et al. Barriers to accessing biologic treatment for rheumatoid arthritis in Greece: the unseen impact of the fiscal crisis—the Health Outcomes Patient Environment (HOPE) study. Rheumatol Int 34, 25–33 (2014). https://doi.org/10.1007/s00296-013-2866-1

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  • DOI: https://doi.org/10.1007/s00296-013-2866-1

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