title: Access to and use of medicines among Syrian asylum seekers and refugees in Germany and the population with government health insurance in Syria
Creators: name: Aljadeeah, Saleh
Publisher: name: University of Bayreuth
Year: 2022
Subjects: subject: Asylum seekers and refugees
subject: Syria
subject: Germany
subject: Access
subject: Barriers
subject: Language
subject: Non-communicable disease
subject: Cardiovascular disease
subject: Diabetes
subject: Medicine
subject: Insulin
subject: Antibiotics
subject: Antimicrobial resistance
subject: Outpatient
subject: Dispensing data
subject: Demography
subject: FOS: Sociology
subject: Drug utilization research
subject: Conflict
subject: Humanitarian healthcare
subject: 610

description: Access to medicines is a critical element of health systems. The importance of medicines in promoting health and curing diseases makes access to medicines a key indicator of a country’s progress towards universal health coverage (UHC). Populations affected by humanitarian crises experience unique challenges in accessing medicines. Drug utilization among these populations is understudied. Therefore, the overall aim of this thesis is to describe drug utilization among two populations: asylum seekers and refugees in Germany, and the population with government health insurance in Syria. This cumulative thesis included four studies. Studies I and II are based on primary patient‐reported data collected via a structured questionnaire from 1,641 Syrian asylum seekers and refugees in North Rhine-Westphalia (NRW), Germany, and analyzed barriers limiting access to medicines, the diagnoses that led to using the medicines as well as the patterns and rates of medicines used. Studies III and IV were based on secondary data acquired from health insurance providers that recorded prescribed medicines dispensed for 81,314 beneficiaries over a 12-month period as outpatient care in regions controlled by the Syrian government. Through these data, we examined the rates and patterns of dispensing outpatient antibiotics, cardiovascular diseases (CVD), and diabetic medicines. Based on these studies, we recommend applying more effort to enhancing the ability of asylum seekers and refugees to learn the German language as a mid- to long-term strategy to overcome language barriers. Particular focus should be placed on female refugees, older refugees, and those with chronic diseases or disabilities. We also recommend providing translated medical leaflets for patients who ask for them. The high prevalence of medicine use for non-communicable diseases (NCDs) medicines we observed among Syrian asylum seekers and refugees in Germany raises the question of whether enough attention has been paid to developing policies and clinical practices to ensure NCDs care in this population. The high rates of outpatient antibiotic dispensing among the population with government health insurance in Syria and high rates of broad-spectrum antibiotic dispensing are concerning as the excessive consumption of broad-spectrum antibiotics may significantly increase antibiotic resistance. On the other hand, the low rates of NCDs medicines dispensing among the population with government health insurance in Syria suggest that these diseases are undertreated in a country affected by conflict, such as Syria. We encourage future studies to pay more attention to the detection, treatment, and management of NCDs among forcibly displaced populations and populations living in conflict zones. More efforts are needed to investigate the quality, availability and affordability of medicines in different settings and among different groups of Syria’s population, especially in the regions that are not under the Syrian government’s control.