How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan.
How conflicts of interest hinder effective regulation of healthcare: an analysis of antimicrobial use regulation in Cambodia, Indonesia and Pakistan.
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DOI：
10.1136/bmjgh-2022-008596
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发表时间：
2022-05
影响因子：
8.1
通讯作者：
Hanefeld, Johanna
中科院分区：
文献类型：
--
作者：
Khan, Mishal;Rahman-Shepherd, Afifah;Bory, Sothavireak;Chhorn, Sophea;Durrance-Bagale, Anna;Hasan, Rumina;Heng, Sotheara;Phou, Socheata;Prien, Chanra;Probandari, Ari;Saphonn, Vonthanak;Suy, Sovanthida;Wiseman, Virginia;Wulandari, Luh Putu Lila;Hanefeld, Johanna
人们对医疗保健政策形成的一个根本力量--利益冲突(COI)--关注不够。我们调查了COI，这导致政策制定者或医疗保健提供者的专业判断受到与抗菌药物使用有关的次要利益的损害，从而阐明了更广泛地监管药品使用的挑战。我们的目标是描述能够创建COI的三个群体--政策制定者、医疗保健提供者和制药公司--之间的联系，并阐明COI对政策过程各个阶段的影响。使用解释性方法，我们系统地分析了来自三个私营医疗保健部门占主导地位的亚洲国家的136次深度访谈和5次焦点小组讨论的定性数据：柬埔寨、印度尼西亚和巴基斯坦。我们描述了三个群体之间普遍存在的四种类型的联系：金融、政治、社会和家庭关系。这些联系产生了强大的COI，可能通过以下方式影响政策进程的所有阶段：防止与药品销售有关的问题在议程上占据突出位置；影响政策制定以采取更软的监管措施；确定政策执行的资源可获得性和反对性；以及确定报告有争议的政策成功的准确程度。我们的多国研究填补了COI如何阻碍有效政策提高医疗质量的经验证据的空白。它表明，COI在影响药物使用的监管方面可以是普遍的，而不是零星的，并强调，除了财务联系外，其他类型的联系应该被视为COI的重要驱动因素。
There has been insufficient attention to a fundamental force shaping healthcare policies—conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the regulation of medicines use more broadly. Our objectives were to characterise connections between three groups—policymakers, healthcare providers and pharmaceutical companies—that can create COI, and elucidate the impacts of COI on stages of the policy process. Using an interpretive approach, we systematically analysed qualitative data from 136 in-depth interviews and five focus group discussions in three Asian countries with dominant private healthcare sectors: Cambodia, Indonesia and Pakistan. We characterised four types of connections that were pervasive between the three groups: financial, political, social and familial. These connections created strong COI that could impact all stages of the policy process by: preventing issues related to medicines sales from featuring prominently on the agenda; influencing policy formulation towards softer regulatory measures; determining resource availability for, and opposition to, policy implementation; and shaping how accurately the success of contested policies is reported. Our multicountry study fills a gap in empirical evidence on how COI can impede effective policies to improve the quality of healthcare. It shows that COI can be pervasive, rather than sporadic, in influencing regulation of medicine use, and highlights that, in addition to financial connections, other types of connections should be examined as important drivers of COI.
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DOI：
10.1016/j.socscimed.2021.113813
发表时间：
2021-04
期刊：
Social science & medicine (1982)
影响因子：
--
作者：
Gautham M;Spicer N;Chatterjee S;Goodman C
通讯作者：
Goodman C
影响因子：
4.5
作者：
Ferdiana A;Liverani M;Khan M;Wulandari LPL;Mashuri YA;Batura N;Wibawa T;Yeung S;Day R;Jan S;Wiseman V;Probandari A
通讯作者：
Probandari A
影响因子：
4
作者：
Gale NK;Heath G;Cameron E;Rashid S;Redwood S
通讯作者：
Redwood S
影响因子：
3.2
作者：
Khan, Mishal S.;Durrance-Bagale, Anna;Hanefeld, Johanna
通讯作者：
Hanefeld, Johanna
影响因子：
3.2
作者：
Goodman C;Kachur SP;Abdulla S;Bloland P;Mills A
通讯作者：
Mills A