Kapsamdışı İlaçlara Erişimin Kısır Döngüsü: Nitel Bir Çalışmadan Elde Edilen Kanıtlar

Abstract

Amaç: Yurtdışından cepten ödemelerle temin edilen ilaçlar, yerel tedavi seçeneklerine kıyasla genellikle daha pahalıdır ve ilaçlar getirildiğinde bile süreç daha da uzar. Bu durum, hem satın alma gücü olanlar hem de olmayanlar için bir kısır döngü yaratır. Bu çalışma, yurtdışından temin edilen ilaçlara erişimle ilgili zorlukları incelemeyi ve paydaşlara bu zorluklara kanıta dayalı çözümler sunmayı amaçlamaktadır. Yöntem: Bu çalışma, Türkiye'de ilaçlara erişimde zorluklarla ilgili 68 hastanın şikayetleriyle nitel içerik analizi yöntemi kullanılarak gerçekleştirilmiştir. Görsel analizler MAXQDA programı kullanılarak yapılmıştır. Bulgular: Hasta ifadelerinde en sık karşılaşılan temalar "mağduriyet", "iletişim sorunları", "ilaç tedarikindeki gecikmeler" ve "yetkili ve politikacıları adres gösterme"dir. Genetik bozuklukları, dermatolojik rahatsızlıkları, organ nakli geçirenleri, kanser, nörolojik hastalıklar, kardiyovasküler sorunlar, romatolojik rahatsızlıklar ve psikiyatrik veya bağımlılıkla ilgili bozukluklardan muzdarip hastalar, ilaç tedarikindeki gecikmelerin tedavilerini engellediğini veya kesintiye uğramaya zorladığını bildirmişlerdir. Ek olarak, hastalar yabancı ilaç tedarik birimleriyle devam eden iletişim sorunlarını belirtmiş, ilaçlara erişimde zorluklar yaşadıklarını ve tedavi alamadıkları için hayal kırıklığı yaşadıklarını ifade etmişlerdir. Sonuç: Bu sorunlara çözüm arayışında, genellikle yetkilileri ve politikacıları sorumlu tutmuşlardır. Bu bulgu, ilaç tedarik birimleri ile hastalar arasında daha etkili bir iletişim ağına duyulan ihtiyacı vurgulamaktadır. Hasta ihtiyaçlarını hızlı bir şekilde karşılamak ve süreçleri daha anlaşılır hale getirmek için yeni bir sistem veya mevcut sistemin yeniden düzenlenmesi gerekmektedir. Hastalar, yurt dışından ilaç tedarikiyle ilgili bilgi eksikliği konusunda endişelerini dile getirmişlerdir.

Keywords

• İlaç erişimi
• satın alınabilirlik
• MAXQDA
• Türkiye

A Vicious Cycle of Access to Excluded Medicines: Evidence from a Qualitative Study

Abstract

Aim: Medications procured through out-of-pocket payments from abroad are often more expensive compared to local treatment options, and the process is further prolonged even when medications are brought in. This situation generates a vicious cycle for both those with purchasing power and those without. This study aims to examine the challenges associated with accessing medications procured from abroad and to provide stakeholders with evidence-based solutions to these challenges. Method: This study was conducted using a qualitative content analysis method with complaints of 68 patients in Türkiye about challenge to access their medications. Visual analyses were conducted using the MAXQDA program. Results: The most frequently encountered themes in patient statements are "victimization," "communication issues", "delays in medicine supply," and "addressing authorities to politicians." Patients with genetic disorders, dermatological conditions, those undergoing transplants, as well as individuals suffering from cancer, neurological diseases, cardiovascular issues, rheumatological conditions, and psychiatric or addiction-related disorders reported that delays in medication supply hindered their treatments or forced them to discontinue them. Additionally, patients indicated ongoing communication problems with foreign drug supply units, expressing difficulties in accessing medications and frustration due to their inability to receive treatment. Conclusion: In seeking solutions to these issues, they often held authorities and politicians accountable. This finding highlights the need for a more effective communication network between drug supply units and patients. A new system or reorganization of the current system is necessary to quickly address patient needs and make processes more understandable. Patients have expressed concerns about a lack of information regarding drug supply abroad.

Keywords

• Access to medication
• affordability
• MAXQDA
• Türkiye

References

1. 1. Yenet A, Nibret G, Tegegne BA. Challenges to the availability and affordability of essential medicines in African countries: A scoping review. Clin Outcomes Res CEOR. 2023;15:443-458. doi: 10.2147/CEOR.S413546.
2. 2. Fuller JM, Barenfeld E, Ekman I. Why do patients struggle with their medicines?—A phenomenological hermeneutical study of how patients experience medicines in their everyday lives. PLoS ONE. 2021;16(8):e0255478. doi: 10.1371/journal.pone.0255478.
3. 3. Krikorian G, Torreele E. We cannot win the access to medicines struggle using the same thinking that causes the chronic access crisis. Health Hum Rights. 2021;23(1):119-127.
4. 4. Atikeler EK, Leufkens HGM (Bert), Goettsch W. Access to medicines in Turkey: Evaluation of the process of medicines brought from abroad. Int J Technol Assess Health Care. 2020;36(6):585-591. doi: 10.1017/S0266462320000872.
5. 5. Gupta S, McColl MA, Guilcher SJT, Smith K. Managing medication cost burden: A qualitative study exploring experiences of people with disabilities in Canada. Int J Environ Res Public Health. 2019;16(17):3066. doi: 10.3390/ijerph16173066.
6. 6. Shukar S, Zahoor F, Hayat K, et al. Drug shortage: Causes, ımpact, and mitigation strategies. Front Pharmacol. 2021;12:693426. doi: 10.3389/fphar.2021.693426.
7. 7. Tiwary A, Rimal A, Paudyal B, Sigdel KR, Basnyat B. Poor communication by health care professionals may lead to life-threatening complications: Examples from two case reports. Wellcome Open Res. 2019;4:7. doi: 10.12688/wellcomeopenres.15042.1.
8. 8. Shore C, Brown L, Hopp WJ. Causes and consequences of medical product supply chain failures. In: Building Resilience into the Nation’s Medical Product Supply Chains. National Academies Press (US); 2022.

9. 9. Acosta A, Vanegas EP, Rovira J, Godman B, Bochenek T. Medicine shortages: Gaps between countries and global perspectives. Front Pharmacol. 2019;10:763.
10. 10. Tan SC, Poh WT, Yong ACH, et al. Challenges and strategies for ımproving access to cancer drugs in Malaysia: Summary of opinions expressed at the 2nd macr ınternational scientific conference 2022. Cancer Manag Res. 2023;15:851-862.
11. 11. Tucker EL, Daskin MS. Pharmaceutical supply chain reliability and effects on drug shortages. Comput Ind Eng. 2022;169:108258. doi: 10.1016/j.cie.2022.108258.
12. 12. Vledder M, Friedman J, Sjöblom M, Brown T, Yadav P. Improving supply chain for essential drugs in low-ıncome countries: Results from a large scale randomized experiment in Zambia. Health Syst Reform. 2019;5(2):158-177. doi: 10.1080/23288604.2019.1596050.
13. 13. Wong WP, Saw PS, Jomthanachai S, Wang LS, Ong HF, Lim CP. Digitalization enhancement in the pharmaceutical supply network using a supply chain risk management approach. Sci Rep. 2023;13(1):22287. doi 10.1038/s41598-023-49606-z.
14. 14. Frydenberg K, Brekke M. Poor communication on patients’ medication across health care levels leads to potentially harmful medication errors. Scand J Prim Health Care. 2012;30(4):234-240. doi: 10.3109/02813432.2012.712021.
15. 15. Tariq RA, Vashisht R, Sinha A, Scherbak Y. Medication dispensing errors and prevention. In: StatPearls. StatPearls Publishing; 2024.
16. 16. Scheckel CJ, Vincent Rajkumar S. Drug importation: Limitations of current proposals and opportunities for improvement. Blood Cancer J. 2021;11(7):132.
17. 17. Çalıkuşu M, Özçelikay G. Opinions of pharmacists in Türkiye on drug shortages and effects on treatment. Hacet Univ J Fac Pharm. 2024;44(1):18-28.
18. 18. Schreier M, Stamann C, Janssen M, Dahl T, Whittal A. Qualitative content analysis: Conceptualizations and challenges in research practice—ıntroduction to the fqs special ıssue “Qualitative Content Analysis I.” Forum Qual Sozialforschung Forum Qual Soc Res. 2019;20(3). doi: 10.17169/fqs-20.3.3393.
19. 19. Ahmed SK. How to choose a sampling technique and determine sample size for research: A simplified guide for researchers. Oral Oncol Rep. 2024;12:100662.
20. 20. VERBI Software. MAXQDA 2022 [computer software]. Published online 2021. Available from maxqda.com.
21. 21. Sterrantino AF. Observational studies: practical tips for avoiding common statistical pitfalls. Lancet Reg Health - Southeast Asia. 2024;25:100415.
22. 22. Sutton J, Austin Z. Qualitative research: Data collection, analysis, and management. Can J Hosp Pharm. 2015;68(3):226-231.
23. 23. Lincoln YS, Guba EG. Naturalistic Inquiry. SAGE Publications, Inc; 1985.
24. 24. Crowley R, Daniel H, Cooney TG, Engel LS; Health and Public Policy Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: coverage and cost of care. Ann Intern Med. 2020;172(2 Suppl):S7-S32.
25. 25. Iseselo MK, Ambikile JS. Medication challenges for patients with severe mental illness: Experience and views of patients, caregivers and mental health care workers in Dar es Salaam, Tanzania. Int J Ment Health Syst. 2017;11(1):17.
26. 26. Burton J, McCaffrey G, Oputu T, Warner B. Medicines Shortages: Solutions for Empty Shelves. Royal Pharmaceutical Society; 2024:76. Accessed June 12, 2025. https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Medicines%20Shortages/Medicines%20Shortages%20-%20Digital%20-%20201124.pdf
27. 27. Barrios C, de Lima Lopes G, Yusof MM, Rubagumya F, Rutkowski P, Sengar M. Barriers in access to oncology drugs — a global crisis. Nat Rev Clin Oncol. 2023;20(1):7-15.
28. 28. Chakraborty S, Rahman T. The difficulties in cancer treatment. Ecancer Medical Science. 2012;6:ed16. doi: 10.3332/ecancer.2012.ed16.
29. 29. Petricca K, Carson L, Kambugu J, Denburg A. Strengthening access to cancer medicines for children in East Africa: Policy options to enhance medicine procurement, forecasting, and regulations. Glob Health Res Policy. 2024;9(1):24. doi: 10.1186/s41256-024-00365-y.
30. 30. Georgopoulou S, Prothero L, D’Cruz DP. Physician–patient communication in rheumatology: A systematic review. Rheumatol Int. 2018;38(5):763-775.
31. 31. Gil-Guillen VF, Balsa A, Bernárdez B, et al. Medication non-adherence in rheumatology, oncology and cardiology: A review of the literature of risk factors and potential interventions. Int J Environ Res Public Health. 2022;19(19):12036.
32. 32. Organisation for Economic Co-operation and Development (OECD). Pharmaceutical Innovation and Access to Medicines. OECD; 2018:192. Accessed June 12, 2025.
33. 33. Vecchio N, Davies D, Rohde N. The effect of inadequate access to healthcare services on emergency room visits. A comparison between physical and mental health conditions. PLoS ONE. 2018;13(8):e0202559. doi: 10.1371/journal.pone.0202559.
34. 34. Carbonell Á, Navarro-Pérez JJ, Mestre MV. Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review. Health Soc Care Community. 2020;28(5):1366-1379. doi: 10.1111/hsc.12968.