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Other GRADE Papers| Volume 154, P146-155, February 2023

Decision criteria for selecting essential medicines and their connection to guidelines: an interpretive descriptive qualitative interview study

  • Thomas Piggott
    Affiliations
    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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  • Lorenzo Moja
    Affiliations
    Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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  • Elie A. Akl
    Affiliations
    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada

    Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
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  • John N. Lavis
    Affiliations
    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada

    McMaster Health Forum, McMaster University, Hamilton, Canada

    Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
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  • Graham Cooke
    Affiliations
    Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
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  • Tamara Kredo
    Affiliations
    Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa

    Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
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  • Hans V. Hogerzeil
    Affiliations
    University Medical Centre, Groningen, Netherlands
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  • Benedikt Huttner
    Affiliations
    Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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  • Pablo Alonso-Coello
    Affiliations
    Iberoamerican Cochrane Center-Servicio de Epidemiología Clínica y Salud Pública, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain

    CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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  • Holger Schünemann
    Correspondence
    Corresponding author. McMaster University, 1280 Main Street, Hamilton, L8S 4K1 Ontario, Canada. Tel.: +1-905-525-9140x26771.
    Affiliations
    Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada

    Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Department of Medicine, McMaster University, Hamilton, Canada
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Published:December 27, 2022DOI:https://doi.org/10.1016/j.jclinepi.2022.12.007

      Abstract

      Background and Objectives

      The World Health Organization Model List of Essential Medicines has led to at least 137 national lists. Essential medicines should be grounded in evidence-based guideline recommendations and explicit decision criteria. Essential medicines should be available, accessible, affordable, and the supporting evidence should be accompanied by a rating of the certainty one can place in it. Our objectives were to identify criteria and considerations that should be addressed in moving from a guideline recommendation regarding a medicine to the decision of whether to add, maintain, or remove a medicine from an essential medicines list. We also seek to explore opportunities to improve organizational processes to support evidence-based health decision-making more broadly.

      Methods

      We conducted a qualitative study with semistructured interviews of key informant stakeholders in the development and use of guidelines and essential medicine lists (EMLs). We used an interpretive descriptive analysis approach and thematic analysis of interview transcripts in NVIVO v12.

      Results

      We interviewed 16 key informants working at national and global levels across all WHO regions. We identified five themes: three descriptive/explanatory themes 1) EMLs and guidelines, the same, but different; 2) EMLs can drive price reductions and improve affordability and access; 3) Time lag and disconnect between guidelines and EMLs; and two prescriptive themes 4) An “evidence pipeline” could improve coordination between guidelines and EMLs; 5) Facilitating the link between the WHO Model List of Essential Medicines (WHO EML) and national EMLs could increase alignment.

      Conclusion

      We found significant overlap and opportunities for alignment between guideline and essential medicine decision processes. This finding presents opportunities for guideline and EML developers to enhance strategies for collaboration. Future research should assess and evaluate these strategies in practice to support the shared goal of guidelines and EMLs: improvements in health.

      Keywords

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