NURS90075 Applications Of Clinical Pharmacology

Introduction

Quality use of medicine involves selecting medicines when the medicine is necessary and ensuring that carers and patients have adequate skills and knowledge concerning using medicines effectively and safely. The Australia National Medical Policy (NMP) recommends a partnership method to improve the effective use of medicine and enhance access to required drugs (Smith, Latter & Blenkinsopp, 2014). The initiatives and activities of the medical industry play a significant role in ensuring that the central objectives of NMP are achieved. One of the goals of NMP is to enhance the Quality Use of Medicine (QUM). The QUM ensures that medicines are used appropriately, safely, efficaciously and judiciously. The medicine industry improves the QUM by ensuring that health practitioners access education and accurate information about medication and their usage. It will enable health practitioners to make better treatment options for patients and also enhance communication with the patients concerning their medicines. This essay aims to critically analyze the domains of QUM that are required in the provision of quality care and safety to patients and also to critically analyze the QUM principles like a partnership, the primacy of consumers and system-based approaches that are essential in creating effective management plan (Dunning, Sinclair & Colagiuri, 2014).

  A physical examination that involves routine checkup is significant in the analysis of type 2 diabetes and in ensuring that the best treatment choice is used and in determining the general health of the patient. In the case scenario, Dr. Hosu first conducted a physical assessment to Martha that involved checking her random plasma glucose level. Dr Hosu suggested further screening for Martha after finding out that her blood pressure was at 165/100 mmHg which indicated an increase, patients with type 2 diabetes are often at risk of getting hypertension because it puts a strain on their blood vessels hence damaging it, the glucose level had increased to 13.1 mmol/L that increases the risk of type 2 diabetes and pulse rate was 96bpm which indicated an increase which increases the chances of type 2 diabetes occurring. The common symptoms that Martha had revealed include polydipsia (increased thirst) and polyuria (frequent urination). Diabetes type 2 is a gene related disorder and Martha being of Maltese background which is prone to diabetes type 2 was at risk of getting the disease. Self-management is essential in managing the diabetes type 2 Martha should be advised on physical exercise, eat healthy foods and lose excess pounds (Al-Khawaldeh, Al-Hassan & Froelicher 2012). Patient education should be conducted to ensure that there is proper medication management. Proper medication management as discussed in the essay supports in improving quality of life because it helps in ensuring that there is right prescription to the right patient and also ensure medicines are taken in the appropriate time.

Quality use of medicine

For quality use of medication to be attained it requires people to be provided with suitable treatment and has knowledge and skills concerning the use of medicine. Health practitioners play a vital role in integrating QUM. Health practitioners help in communicating with clients, providing the best treatment and in collaborating with other health-related practitioners (Davis, 2014). Dr. Hosu help in promoting QUM through requesting further tests for Martha and also describes the best pharmacological therapy.  He also collaborates with other health practitioners in carrying out the diagnosis for Martha to ensure that Martha receives the best treatment. The Council of Australian Governments requires that systems for community and health services delivery should provide efficient care according to people’s requirements, provide encouragements for preventive care and health effective care, and maintain the benefit of universal access of health services through Medicare (Elliott et al, 2012).

  The main aim of the National Medicines Policy (NMP) is to focus on people’s need and bring individual knowledge, skills, and experience to enhance QUM (Wirtz et al, 2017). NMP ensures that there is timely access to medicine and also provides the dose produced to meet the appropriate standards, NMP is also responsible for maintaining a viable and accountable medicine industry (Vasconcelos, Chaves, Azeredo & Silva, 2017). The Pharmaceutical Benefits Advisory Committee (PBAC) provides recommendations and advice on medicines that should be included on Australia’s Pharmaceutical Benefits and Scheme (PBS). The PBAC considers the QUM- related factors into consideration like course length, cost-effectiveness and alternative therapies (Mellish et al, 2015).

  A recent study by the World Health Organization (WHO) about medical products and the harm they cause highlights the potential risks of not following the QUM keenly. However, providing the accurate estimates of the harm is a significant challenge.  A literature review was carried out using databases. 100 papers from the 88 member states of WHO were included in the study; the documents represented a survey of the quality of medicines in the member states. The survey was conducted using convenience or random sampling methods in conducting data collection, and 42-214 samples of drugs were included in the survey. The medicine samples were analyzed in the laboratory and find out that approximately 10.5% of medicines were falsified and substandard in low and middle countries. According to the study falsified and substandard drugs cause a threat to the health of the patient and undermine the capability of medicines to prevent or treat diseases (Attaran et al, 2012). The government should invest in strategies in safeguarding the supply, manufacture, and distribution of medical products produced (Kovacs, Hawes, Maley, Mosites, Wong & Stergachis, 2014). The study had limitations like the lack of systematic data collection this shows that there is a knowledge gap between the consequences of lack of QUM. Although furthers studies have been carried out more research is required to determine the quality of drugs in the industry. Further research is recommended to assess the threat posed by falsified and substandard medical products.

Domains of Quality Use of Medicine

Quality use of Medicine involves the judicious and safe use of medicine by the public. The four essential domains of Quality Use of Medicine are; selection of management options wisely, choosing the best medicine, using medicine safely and use medicine effectively.

Selection of a management plan

During the selection of an effective management plan, one should consider the place of prescription in maintaining the wellbeing of the individual and in treating the illness.  Dr. Hosu described metformin medication to Martha as the first step in trying to reduce the type 2 diabetes. According to a study by the American College of Physicians and the American Diabetes Association metformin should be the first treatment for type 2 diabetes (American Diabetes Association, 2015). Metformin is also described to a person who is overweight as in the case of Martha (Frass et al, 2012).

Choosing the best medicine

The General Practitioners (GP) should choose the best medicine from the available options. The best medicine should be selected considering; the benefits and risks, costs for the community, length of treatment and dosage, and monitoring considerations. Dr. Hosu prescribes Caduet to Martha that contains amlodipine and atorvastatin. Caduet help in reducing cholesterol that will help in lowering blood sugar hence reduction in plasma glucose in Martha.

GP require to have adequate skills and knowledge about medicines to prescribe the best medication. They need to have access to accurate and current information, education and electronic supports (Tenforde, Nowacki, Jain & Hickner, 2012). The resources that can help the GP to improve their knowledge about drugs include; Therapeutic Guidelines (Lefaucheur et al, 2014), Australian Prescriber (Sansom, 2014) and Australian Medicines Handbook (Buckley, 2016). General Practitioners have a professional and ethical obligation to manage the risk of influences on the prescribing relationship between media, industry sources, and advertising. The Australian Medicines Handbook is a validation that is based on independent medicines reference which is preferred by many of clinicians in the Australian healthcare sector. (Australian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT), Pharmaceutical Society of Australia (PSA) &The Royal Australian College of General Practitioners (RCGP), 2017)

Using medicines safely

For the patient to use the drug safely, she should minimise underuse, overuse or misuse. As in the case study, Martha must ensure that she takes medicine as prescribed.  The GP needs to maintain open communication with their clients to maximise medicine safety and minimise potential risks of drugs (Ostini, Roughead, Kirkpatrick, Monteith & Tett, 2012). Open communication is also an essential factor in ensuring the QUM because it helps the GP to identify medicines that the patient is taking that were not initiated by him or her. Research shows that two-thirds of patient use complementary medicine and sometimes do not disclose to the General Practitioners this reduces the safety of medicines.

Using medicine effectively

General Practitioners can enhance medicine effectiveness through printing or writing simple legal prescriptions that the patients can easily understand. Dr. Hosu uses simple language to prescribe medicine for Martha, for example, Martha should take Caduet once daily. This help in minimizing patient’s confusion hence enhancing effectiveness. Sufficient description of medicine helps in improving the patient capacity of solving problems concerning medication such as adverse side effects (Reid, Steel, Wardle, Trubody & Adams, 2016).

A conceptual framework for Quality Use of Medicine

It describes the schemes for implementing policies to achieve QUM. It uses principles from behavior change, health promotion, and public health. The framework emphasis on the need to use various perspectives (community development, individual and public health) in evaluating, implementing and planning in improving the use of medicine. It is a multilevel, multi-strategic and systematic approach that includes all the people whose activities affect QUM, encompasses stages of learning that maintain and support QUM including the improvement in knowledge, skills, awareness, motivation, and behaviors, and addresses all issues which decisions and problem affect QUM. Such a scheme is important because organizations and individuals will be at different levels and are ready to take suitable actions to maintain and achieve QUM (Cole & Bird, 2013). The levels of QUM are;

Level 1 is the awareness level. In this level awareness of medicine is important as a health concern and it helps in changing, informing and exploring community beliefs and attitudes about the benefit and risks interrelated with medicines. It is in this level that the necessary information about resources that are available is provided to enhance QUM (Mak, Clark, Poulsen, Udengaard & Gilbert, 2012). Dr. Hosu is aware that medicine is necessary for the treatment of type 2 diabetes and that’s why he describes the essential drug. Martha also needs to know that people with Maltese background are more prone to diabetes type 2 this could have helped her in managing the disease early through a continuous exercise to reduce overweight. Statistics show that 10% of people with Maltese background have diabetes type 2 especially from the age of 45 years (Ley, Hamdy, Mohan & Hu, 2014).

Level 2 is the level that helps in the development of skills and knowledge. In this level, the General Practitioners is provided with an opportunity to develop skills and knowledge and also utilize available resources to make suitable decisions. It also provides people with a chance to discuss QUM issues and to adopt and try behaviors that enhance QUM and deliver effective health outcomes. Martha requires to effectively use the medicine prescribed to her to ensure that she achieves better health outcomes (Kislov, Waterman, Harvey & Boaden, 2014).

Level 3 is the level concerning the evaluation and action. It maintains and reinforces actions that are required in using medicine effectively and wisely. It involves issues of quality improvement, positive reinforcement and feedback, monitoring outcomes and problem-solving. Dr. Hosu can evaluate Martha conditions in order to apply practical techniques in solving Martha’s problems. The healthcare providers have an obligation of integrating conventional and complementary care using QUM framework in order to ensure the holistic ability to treat their patients. The holistic approach enables the healthcare providers to fill therapeutic gaps and broaden the scope of treatment options available for their patients in order for their services to provide treatment for the whole person (Dunning, 2012).

Implications of quality use of medicine

QUM enhances timely access to medicine at the time patient need them. It ensures that the patients understand the reason they have been prescribed a particular medicine and how they can use the medicine effectively to enable them to heal. QUM ensures that the healthcare professionals have evidence-based information that they require in order to prescribe a medicine effectively. If a medicine is not needed then it should not be specified, and the health care professionals should prescribe the best option from the available alternatives, the alternatives should include non-medication practices. In the case study, Dr. Hosu prescribed drugs as the first step but also recommends Martha to education sessions.

QUM applies equally to non-prescription, complementary and prescription medicines (Harris, Cooper, Relton & Thomas, 2012). It’s emphasis on the importance of healthcare professionals and patients having accurate information concerning the medicine. Access to accurate information is helpful in making rational decisions about medicine and their uses. As in the case study due to diagnosis performed to Martha Dr. Hosu has precise information due to this he can prescribe the best medicines.

QUM also provides the necessary methods to evaluate the outcome of the treatment option selected and to allow for modification according to the outcome. This will ensure that optimal outcomes are achieved and maintained (Cohen, Lawson, Graudins, Pearson & Gazarian, 2012).

Medication management plan

For developing an effective medication plan for a patient, one needs to consider the principles of Quality Use of Medicines. Some of the medication management plans for diabetes type 2 patient include;

Patients and health providers should focus on monitoring and assessment of medicines outcomes. Pharmaceuticals substances should be considered because they have medicinal properties (Rang, Dale, Ritter & Flower, 2016). The health providers’ knowledge helps them to ensure the safety and effectiveness of the medicines they prescribe to the patients. It is the role of health providers to adjust medicines with the adverse side effect. The patient also requires skills to effectively help in self-monitoring and knowing the side effects of medicine (Powers et al, 2017).

The QUM principle of partnership is essential in ensuring that patients and health providers work in partnership to ensure that medicines achieve the best outcome (Lim, Siegel, Sunderland, Chan & Nissen, 2014). Martha should work in partnership with Dr. Hosu in ensuring that the medicines do not affect her and reports any side effect.

Health providers and patients require adequate education during the prescribing process of the drug. They should consider the risks and benefits of the medicine they prescribe, and benefits should overweigh the risks. They should adequately prescribe the dosage using a simple language and consider a non-medication practice. Martha diabetes is controllable since her ketones results are negative the General Practitioner should have considered non-medication practices like Martha should stop smoking and exercise regularly (Khunti et al, 2012). Martha requires education on the medicine prescribed to her to ensure that the correct medicine was prescribed and she can understand the prescription to avoid misuse, overuse or underuse. The QUM principle of collaborative, consultative and multi-disciplinary activity should be utilized in the prescription in ensuring that the health providers provide the best treatment option.

The QUM principle of system-based approaches requires an education session to assist in the storage of medicines. Medicine should be stored efficiently in order to meet the legislative and manufacture requirements (Bullock & Manias, 2013). The system-based approach requires all the stakeholders to cultivate behaviors in support of QUM. For example, the patient needs to store medicine safely at their homes in order to ensure that they meet the set standards of quality use of medication. Martha has been referred to an education session in order to ensure that her behaviors adhere to QUM (Buckley, Stasa, Cashin, Stuart & Dunn, 2015).

The QUM principle of the primacy of consumers requires that supportive education should be offered to health care providers in order to ensure that patients are involved in all aspect. Consumer autonomy should be allowed and encouraged always. Health providers should make actual decision of possible solutions in case of non-adherence to the independence of the consumers. Martha requires education on autonomy in order to ensure that she makes decisions concerning her health. Martha requires education concerning her lifestyle. Martha has been smoking for the last 25 years which is a threat to her health conditions. For effective medication management she should be provided with education on the dangers of smoking to her medication this will ensure that medicines are effective.

Implications for medication management plan

Medication management is the adherence to the medicines the patient has been described. In public health, the rate of non-adherence in chronic diseases is increasing (Hernandez-Tejada, Campbell, Walker, Smalls, Davis & Egede, 2012). A recent study was conducted to evaluate the impact of medication management on cost and healthcare utilization. The study was carried out using a retrospective cohort observation of individuals who were enrolled in prescription and medical benefits plan. The study consisted of the population-based sample of 132277 of patients under the age of 65. The cost of drugs, medical-related expenses, and hospitalization that arises due to non-adherence was measured. The study showed that with medical management the medical expense was reduced and also the hospitalization rate reduced (Sokol, McGuigan, Verbrugge & Epstein, 2005). But further research is recommended to ensure that there is a full intervention that will enhance adherence to medicines and in encouraging the patient with diabetes to initiate pharmacotherapy (Feil, Zhu & Sultzer, 2012). In the case study, Martha requires education on medication management to ensure that he adheres perfectly to her medication to avoid more complications, hospitalization and reduce the cost of drugs.

The knowledge of basics and clinical pharmacology is essential in developing an effective management plan. It helps the General Practitioners during prescription of drugs because it will assist them in understanding substances that can interact with normal body processes and living systems through chemical processes and hence provide a guideline to their patient on correct medication (Panula et al, 2015). Implications of a medication management plan include;

Correct medication management help in reducing costs because fewer people are likely to be hospitalized due to neglecting to take prescribed medications or incorrect dosing.

There is a reduction in duplication, drug interactions and side effects of all the medicines that are being taken.

Correct medication management plan helps in increasing the patient’s percentage of meeting their goals for acquiring the medicines.

Correct medication management help in improving patient administration and use of all medication (McMullen et al, 2015).

Conclusion

It is evident from the essay that the domains of Quality Use of Medicine are necessary for ensuring quality and safe care. QUM also assists in ensuring timely access to medicines and in the evaluation of the treatments administered to the patient. For QUM to be achieved all the stakeholders like care givers and patients, require adequate skills and knowledge, and also they are required to have the capacity to choose the effective medicines. NMP has enhanced QUM by focusing on people’s need and bringing together individual’s experience, knowledge, and skills. The QUM framework plays a significant role by emphasizing on the need to use various perspectives like the individual and public health in implementing, planning and evaluating in improving the use of medicine.

Healthcare providers have an obligation of ensuring that they follow the Quality Use of Medicine principles like a partnership and ensuring they work in a consultative, collaborative and multidisciplinary way when providing treatments in order to ensure that they develop an effective medication plan to the patients. The partnership is fundamental in ensuring that there is QUM since organizations and individuals have different priorities and different working ways. It will help serve the consumers perfectively. The collaboration of different perspectives and expertise in dealing with the barriers and drivers of each player is essential in ensuring a successful QUM partnership. In the case scenario, the medication plan of Martha that included caduet, metformin and cessation of Lisinopril assisted in the management of type 2 diabetes that Martha suffered from.  An effective management plan is essential to all patients since it enhances the adherence to the medicines prescribed.

References

Al-Khawaldeh, O. A., Al-Hassan, M. A., & Froelicher, E. S. (2012). Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus. Journal of Diabetes and its Complications, 26(1), 10-16.

American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 33(2), 97.

Attaran, A., Barry, D., Basheer, S., Bate, R., Benton, D., Chauvin, J., … & Newton, P. N. (2012). How to achieve international action on falsified and substandard medicines. Bmj, 345, e7381.

Australian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT), Pharmaceutical Society of Australia (PSA), The Royal Australian College of General Practitioners (RCGP) (2017). Australian medicines handbook. Adelaide: ASCEPT, PSA, RCGP.

Buckley, N. (Ed.). (2016). Australian Medicines Handbook 2016. Australian Medicines Handbook.

Buckley, T., Stasa, H., Cashin, A., Stuart, M., & Dunn, S. V. (2015). Sources of information used to support quality use of medicines: findings from a national survey of nurse practitioners in Australia. Journal of the American Association of Nurse Practitioners, 27(2), 87-94.

Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education AU.

Cohen, S. A., Lawson, J. A., Graudins, L. V., Pearson, S. A., & Gazarian, M. (2012). Changes in anticonvulsant prescribing for Australian children: implications for quality use of medicines. Journal of paediatrics and child health, 48(6), 490-495.

Cole, S. A., & Bird, J. (2013). The Medical Interview E-Book: The Three Function Approach. Elsevier Health Sciences.

Davis, J. (2014). Quality use of medicines. Australian Nursing and Midwifery Journal, 21(8), 26.

Dunning, T. (2012). Integrating complementary and conventional care using quality use of medicines as a framework (pp. 17-32). InTech.

Dunning, T., Sinclair, A., & Colagiuri, S. (2014). New IDF Guideline for managing type 2 diabetes in older people. Diabetes research and clinical practice, 103(3), 538-540.

Elliott, R. A., Tran, T., Taylor, S. E., Harvey, P. A., Belfrage, M. K., Jennings, R. J., & Marriott, J. L. (2012). Gaps in continuity of medication management during the transition from hospital to residential care: an observational study (MedGap Study). Australasian journal on ageing, 31(4), 247-254.

Feil, D. G., Zhu, C. W., & Sultzer, D. L. (2012). The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. Journal of behavioral medicine, 35(2), 190-199.

Frass, M., Strassl, R. P., Friehs, H., Müllner, M., Kundi, M., & Kaye, A. D. (2012). Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. The Ochsner Journal, 12(1), 45-56.

Harris, P. E., Cooper, K. L., Relton, C., & Thomas, K. J. (2012). Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update. International journal of clinical practice, 66(10), 924-939.

Hernandez-Tejada, M. A., Campbell, J. A., Walker, R. J., Smalls, B. L., Davis, K. S., & Egede, L. E. (2012). Diabetes empowerment, medication adherence and self-care behaviors in adults with type 2 diabetes. Diabetes technology & therapeutics, 14(7), 630-634.

Khunti, K., Gray, L. J., Skinner, T., Carey, M. E., Realf, K., Dallosso, H., … & Davies, M. J. (2012). Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care. Bmj, 344, e2333.

Kislov, R., Waterman, H., Harvey, G., & Boaden, R. (2014). Rethinking capacity building for knowledge mobilisation: developing multilevel capabilities in healthcare organisations. Implementation Science, 9(1), 166.

Kovacs, S., Hawes, S. E., Maley, S. N., Mosites, E., Wong, L., & Stergachis, A. (2014). Technologies for detecting falsified and substandard drugs in low and middle-income countries. PLoS One, 9(3), e90601.

Lefaucheur, J. P., André-Obadia, N., Antal, A., Ayache, S. S., Baeken, C., Benninger, D. H., … & Devanne, H. (2014). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology, 125(11), 2150-2206.

Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-2007.

Lim, D., Siegel, E., Sunderland, V. B., Chan, V., & Nissen, L. (2014). A QUM partnership approach to regulating biosimilars in Australia. In National Medicines Symposium 2014: Medicines in Health-Shaping Our Future (p. 57). NPS Medicinewise.

Mak, V. S., Clark, A., Poulsen, J. H., Udengaard, K. U., & Gilbert, A. L. (2012). Pharmacists’ awareness of Australia’s health care reforms and their beliefs and attitudes about their current and future roles. International Journal of Pharmacy Practice, 20(1), 33-40.

McMullen, C. K., Safford, M. M., Bosworth, H. B., Phansalkar, S., Leong, A., Fagan, M. B., … & Burkholder, R. (2015). Patient-centered priorities for improving medication management and adherence. Patient education and counseling, 98(1), 102-110.

Mellish, L., Karanges, E. A., Litchfield, M. J., Schaffer, A. L., Blanch, B., Daniels, B. J., … & Pearson, S. A. (2015). The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers. BMC research notes, 8(1), 634.

Ostini, R., Roughead, E. E., Kirkpatrick, C. M., Monteith, G. R., & Tett, S. E. (2012). Quality Use of Medicines–medication safety issues in naming; look?alike, sound?alike medicine names. International Journal of Pharmacy Practice, 20(6), 349-357.

Panula, P., Chazot, P. L., Cowart, M., Gutzmer, R., Leurs, R., Liu, W. L., … & Haas, H. L. (2015). International union of basic and clinical pharmacology. XCVIII. Histamine receptors. Pharmacological reviews, 67(3), 601-655.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.

Rang, H.P., Dale, M.M., Ritter, J.M. & Flower R. (2016). Pharmacology, 8th ed. Philadelphia: Elsevier Churchill Livingstone.

Reid, R., Steel, A., Wardle, J., Trubody, A., & Adams, J. (2016). Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use. BMC complementary and alternative medicine, 16(1), 176.

Sansom, L. (2014). Australian pharmaceutical formulary and handbook. Pharmaceutical Society of Australia.

Smith, A., Latter, S., & Blenkinsopp, A. (2014). Safety and quality of nurse independent prescribing: a national study of experiences of education, continuing professional development clinical governance. Journal of advanced nursing, 70(11), 2506-2517.

Sokol, M. C., McGuigan, K. A., Verbrugge, R. R., & Epstein, R. S. (2005). Impact of medication adherence on hospitalization risk and healthcare cost. Medical care, 521-530.

Vasconcelos, D. M. M. D., Chaves, G. C., Azeredo, T. B., & Silva, R. M. D. (2017). National Medicines Policy in retrospective: a review of (almost) 20 years of implementation. Ciencia & saude coletiva, 22(8), 2609-2614.

Wirtz, V. J., Hogerzeil, H. V., Gray, A. L., Bigdeli, M., De Joncheere, C. P., Ewen, M. A., … & Möller, H. (2017). Essential medicines for universal health coverage. The Lancet, 389(10067), 403-476.