(ID: 49) Accessing supplies of prescribed medication for long-term conditions and its contribution to treatment burden: a rapid review of the literature

Introduction Treatment burden can be defined as “the workload of health care as well as its impact on patient functioning and well-being” [1]. It extends beyond the time needed to undertake treatments and includes activities such as ordering and sourcing supplies of prescribed medicines. Currently little is known about the extent to which these activities contribute to the treatment burden of individuals with long-term conditions (LTCs). Aim To undertake a rapid review of the literature on the experiences of people with LTCs in accessing supplies of prescribed medicines, and the impact this has on treatment burden. Methodology A rapid review of the literature was conducted following best practice recommendations [2]. After refinement of search terms, three databases (Ovid, Embase and APA PsycInfo) were searched in July 2024. Search terms included keywords related to treatment burden and medicine access or supply. Eligible studies included people (or their carers or parents) with a LTC where access to prescribed medicines and treatment burden were assessed or explored. Exclusion criteria were acute health conditions, the process of taking or administering medicines, disease burden and global economic burden of treatment. Articles published prior to 2012, where full text was unavailable, not in the English language or non-peer reviewed were excluded. Two reviewers screened ten percent of articles at both title and abstract and full-text screening stages. Data extraction was performed, and the methodological quality of the studies was critically appraised using the Mixed Methods Appraisal Tool (MMAT) [3]. Due to the heterogeneity of methods and outcomes reported, data were analysed using a narrative synthesis. Ethical approval was not required as this was a review of published data. Results Initial searches identified 441 studies. Following title and abstract and full-text screening, 12 studies were included in the review. Four studies were quantitative, four were qualitative, and four used a mixed methods approach. Geographic location of studies included the Americas, Africa and the United Kingdom. Five studies utilised a validated questionnaire to measure treatment burden - Treatment Burden Questionnaire (TBQ) [4] or Multimorbidity Treatment Burden Questionnaire (MTBQ) [5] which includes one question relating to difficulty in collecting prescription medication. Of the two studies utilising the MTBQ, a UK study found that 23.8% of participants reported some difficulty in collecting prescription medication, compared with 80.6% of participants in an Ethiopian study. Synthesis of qualitative findings related to: Stock availability; Insurance coverage or authorisation requirements; Affordability of medicines and strategies to reduce cost; Travel to pharmacies or hospital; Home delivery; Communication between healthcare providers and Prescribing errors or delays. Discussion The findings provide meaningful insights into how the process of accessing prescribed medicines contributes to treatment burden. While some findings, such as insurance coverage, are not directly applicable to the UK, others highlight potential areas for service development and strategies to reduce treatment burden. As a rapid review was conducted, the full breadth of the literature may not be presented. Further research is needed in this area to quantify the extent to which accessing medicine supplies contributes to treatment burden for patients with LTCs.