Essential Medicine Lists (EMLs) are important for the prioritization and availability of medicines around the world. Since the first Model List of Essential Medicines (MLEM) from the World Health Organization in 1977, the list has expanded from 208 to 479 medicines. The availability of essential medicines is a key priority under the World Health Organization’s Universal Health Coverage agenda & the United Nation’s Sustainable Development Goals (in particular goal 3.8 Coverage of Essential Health Services). EMLs are an important tool to inform health decisions at a country-level and at least 137 countries now have their own national EML. Despite this, there is wide variability in the methods used to develop them, and the certainty of evidence of medicines included on WHO’s MLEM and national EMLs. Additionally, a lack of coordination may result in time delays in updating EMLs or unnecessary duplication of efforts between EMLs and other evidence synthesis and health decision-making paradigms, such as health guidelines. In this thesis, we seek to understand the decision-making process for EMLs with particular focus on WHO’s MLEM, and to identify and advance opportunities to coordinate their development with health guidelines. This is accomplished through three papers, which build upon each other in this sandwich thesis. Paper 1 is a qualitative interview study with EML and guideline stakeholders to better understand decision-criteria and processes in EMLs. Paper 2 evaluates, using user-experience testing, a framework for the connection of guidelines and EMLs using an Evidence-to-Decision (EtD) framework for EMLs. Paper 3 presents a stakeholder-driven Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group concept paper exploring the conceptual challenges and opportunities of linking guidelines and EMLs using case studies on real-world implementation of this connection. / Thesis / Doctor of Philosophy (PhD) / Medicines are important for treating health conditions, and the most important medicines are called essential medicines. Essential Medicine Lists (EMLs) are created to determine what should be considered an essential medicine around the world, and also to ensure people have access to them. The number of medicines on the World Health Organization’s Model List of Essential Medicines (MLEM) has grown since it was first released, but these medicines aren’t always available to treat people who need them. Sometimes medicines that are not the most important are included on national essential medicine lists. The way that the WHO EML and national EMLs are made has been under review and criticized. Health guidelines tell people how medicines should be used, however, the connection between EMLs and health guidelines is not always consistent. Sometimes they may say different things about the same medicine. Additionally, there are differences in how EMLs and guidelines are established, and those involved do not always work with each other. In this thesis, I try to understand how decisions about which medicines are included in EMLs are made, and how they connect to health guidelines. Chapter 1 is an introduction to the topic. Chapter 2 asks experts about the decision-making process for EMLs. In chapter 3, we change a tool for guidelines to help connect guideline and EML decisions and ask for feedback regarding improvements. Chapter 4 presents the work with a group of guideline experts to present problems and suggest ways to overcome them to make EMLs and health guidelines better connected.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/28282 |
| Date | January 2022 |
| Creators | Piggott, Thomas |
| Contributors | Schünemann, Holger, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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