An essential medicines list in Ireland: A qualitative interview study of interest-holders

BackgroundThe World Health Organization recommends each country develop a national essential medicines list (NEML), prioritising a core medicines set aligned with national health needs. Policy in Ireland partly focusses on prescribing costs and quality, which creates opportunities for NEML development. We aimed to explore interest-holders perspectives on an Irish NEML. MethodsWe applied a descriptive qualitative methodology. Using purposive and snowball sampling, we recruited interest-holders from Irish bodies/groups with roles in shaping Irelands medicines policy/use with potential for involvement in a NEML. Semi-structured interviews were conducted and analysis involved Braun and Clarkes six-stage approach to thematic analysis. ResultsThirteen participants were interviewed and three themes were generated: 1) the NEMLs purpose, 2) NEML barriers and facilitators and 3) development and implementation processes. For participants, an NEMLs purpose is meeting the populations priority needs. Participants also outlined roles in ensuring adequate supplies and as a national formulary. Views differed on whether an NEML should involve reduced costs to patients for access. Participants proposed that the national government health department, the state body who run the health service (HSE), and/or the medicines regulator (HPRA) should be responsible for an NEML. ConclusionsParticipants perceived an NEML in Ireland as beneficial and aligning with the WHOs vision: medicines that effectively and safely treat the priority healthcare needs of the population. Future work should explore the patients and the publics perspectives on an NEML. Other countries NEMLs offer exemplars to inform Irelands approach. Research in ContextO_ST_ABSWhat is already known about the topic?C_ST_ABSAccording to The World Health Organization, "each country has the direct responsibility of evaluating and adopting a list of essential drugs, according to its own [health] policy." These national essential medicines lists (NEMLs) can be used to standardising medications used across healthcare institutions. This can have benefits for procurement costs, patient safety and preventing shortages. What does this study add to the literature?We interviewed 13 medicines policy interest-holders about an Irish NEML. Participants envisioned an NEML as meeting the populations priority needs. They also outlined roles for an NEML in ensuring supplies and as a national formulary. Barriers (e.g. achieving consensus) and facilitators (e.g. buy-in) to developing and implementing an NEML were outlined. Participants said transparent development processes, the use of financial incentives and a communications strategy, could help overcome barriers. Participants proposed that the national government health department, the state body who run the health service (HSE), and/or the medicines regulator (HPRA) should be responsible for an NEML. What are the policy implications?An NEML could fit into Irelands ongoing health reform policy: Slaintecare. Participants suggested strategies for overcome NEML barriers are backed-up by findings in other high-income countries (e.g. Sweden and Canada) where transparency, financial incentives and a communications strategy contributed to NEML success.