Show simple item record

Files in this item


Item metadata

dc.contributor.authorfor the Carefully Selected and Easily Accessible at No Charge Medicines (CLEAN Meds) Study Team
dc.contributor.authorPersaud, Nav
dc.contributor.authorBedard, Michael
dc.contributor.authorBoozary, Andrew
dc.contributor.authorGlazier, Richard H.
dc.contributor.authorGomes, Tara
dc.contributor.authorHwang, Stephen W.
dc.contributor.authorJuni, Peter
dc.contributor.authorLaw, Michael R.
dc.contributor.authorMamdani, Muhammad
dc.contributor.authorManns, Braden
dc.contributor.authorMartin, Danielle
dc.contributor.authorMorgan, Steven G.
dc.contributor.authorOh, Paul
dc.contributor.authorPinto, Andrew D.
dc.contributor.authorShah, Baiju R.
dc.contributor.authorSullivan, Frank
dc.contributor.authorUmali, Norman
dc.contributor.authorThorpe, Kevin E.
dc.contributor.authorTu, Karen
dc.contributor.authorLaupacis, Andreas
dc.identifier.citationfor the Carefully Selected and Easily Accessible at No Charge Medicines (CLEAN Meds) Study Team , Persaud , N , Bedard , M , Boozary , A , Glazier , R H , Gomes , T , Hwang , S W , Juni , P , Law , M R , Mamdani , M , Manns , B , Martin , D , Morgan , S G , Oh , P , Pinto , A D , Shah , B R , Sullivan , F , Umali , N , Thorpe , K E , Tu , K & Laupacis , A 2021 , ' Adherence at 2 years with distribution of essential medicines at no charge : the CLEAN Meds randomized clinical trial ' , PLoS Medicine , vol. 18 , no. 5 , e1003590 .
dc.identifier.otherRIS: urn:9F196F613D5A100A27A8A5BCB133AC64
dc.identifier.otherORCID: /0000-0002-6623-4964/work/94669866
dc.descriptionFunding: This work is supported by the Canadian Institutes for Health Research (NP, 381409,, the Ontario SPOR Support Unit (NP, OSSU,, and the St. Michael’s Hospital Foundation (NP, Funded by the Canadian Institutes of Health Research and the Ontario SPOR Support Unit.en
dc.description.abstractBackground Adherence to medicines is low for a variety of reasons, including the cost borne by patients. Some jurisdictions publicly fund medicines for the general population, but many jurisdictions do not, and such policies are contentious. To our knowledge, no trials studying free access to a wide range of medicines have been conducted. Methods and findings We randomly assigned 786 primary care patients who reported not taking medicines due to cost between June 1, 2016 and April 28, 2017 to either free distribution of essential medicines (n = 395) or to usual medicine access (n = 391). The trial was conducted in Ontario, Canada, where hospital care and physician services are publicly funded for the general population but medicines are not. The trial population was mostly female (56%), younger than 65 years (83%), white (66%), and had a low income from wages as the primary source (56%). The primary outcome was medicine adherence after 2 years. Secondary outcomes included control of diabetes, blood pressure, and low-density lipoprotein (LDL) cholesterol in patients taking relevant treatments and healthcare costs over 2 years. Adherence to all appropriate prescribed medicines was 38.7% in the free distribution group and 28.6% in the usual access group after 2 years (absolute difference 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004). There were no statistically significant differences in control of diabetes (hemoglobin A1c 0.27; 95% CI −0.25 to 0.79, p = 0.302), systolic blood pressure (−3.9; 95% CI −9.9 to 2.2, p = 0.210), or LDL cholesterol (0.26; 95% CI −0.08 to 0.60, p = 0.130) based on available data. Total healthcare costs over 2 years were lower with free distribution (difference in median CAN$1,117; 95% CI CAN$445 to CAN$1,778, p = 0.006). In the free distribution group, 51 participants experienced a serious adverse event, while 68 participants in the usual access group experienced a serious adverse event (p = 0.091). Participants were not blinded, and some outcomes depended on participant reports. Conclusions In this study, we observed that free distribution of essential medicines to patients with cost-related nonadherence substantially increased adherence, did not affect surrogate health outcomes, and reduced total healthcare costs over 2 years.
dc.relation.ispartofPLoS Medicineen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectRM Therapeutics. Pharmacologyen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.titleAdherence at 2 years with distribution of essential medicines at no charge : the CLEAN Meds randomized clinical trialen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Sir James Mackenzie Institute for Early Diagnosisen
dc.contributor.institutionUniversity of St Andrews. Population and Behavioural Science Divisionen
dc.description.statusPeer revieweden

This item appears in the following Collection(s)

Show simple item record