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Distributing essential medicines for free resulted in a 44 per cent increase in adherence, some improved health outcomes: study

Toronto, October 7, 2019

By Jennifer Stranges

Dr. Nav Persaud
Dr. Nav Persaud

A new study out of St. Michael’s Hospital’s MAP Centre for Urban Health Solutions found that distributing essential medicines at no charge to patients resulted in a 44 per cent increase in people taking their medications.

The study, publishing on Oct. 7 in JAMA Internal Medicine, also found that participants experienced a reduction in systolic blood pressure and that free distribution of essential medicines led to a 160 per cent increase in the likelihood of participants being able to make ends meet.

The list of 128 essential medicines made available in the study was adapted from the WHO Model List of Essential Medicines and based on Canadian clinical practice guidelines, suggestions from clinicians and patients, prescribing volumes and evidence syntheses. The medicines in the study included treatments for acute conditions, such as antibiotics and pain relievers, as well as chronic conditions, such as antipsychotics and HIV-AIDS medications.

“It is sad that in a high-income country like Canada, millions of Canadians cannot afford their prescribed medications – including life-saving medicines such as insulin,” said Dr. Nav Persaud, a clinician-scientist at the Li Ka Shing Knowledge Institute of St. Michael’s and lead author of the study.

“We hope that our findings help inform public policy changes. This is no longer a question of whether free distribution of medicines can improve health outcomes. It is a question of whether governments will act.”

A total of 786 patients across nine primary care sites in Ontario who reported cost-related non-adherence to medications participated in the study. Most of the study participants were recruited from St. Michael’s Department of Family and Community Medicine.

Participants were assessed at 12 months into the three-year study. Participants in the intervention arm of the study were randomly allocated to receive free distributions of essential medicines, while others in the control arm of the study had only their usual access to medication.

Dr. Persaud said Canada is considered a suitable setting to measure the effects of free medicine distribution because health care services such as physician visits and hospitalizations are publicly funded while there are cost barriers to medications.


This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.


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