Review Highlights Importance of Medicine Delivery Systems for Chronic Disease Management

Optimizing Medicine Delivery: A Global Challenge for Chronic Disease Management

A recent review published in The Lancet Primary Care examined how various medicine delivery models influence patient access, affordability, and adherence to long-term treatment for chronic diseases across different health systems.

The review concluded that no single delivery model is universally optimal, and effectiveness depends on specific contexts, regulations, patient needs, and local infrastructure.

Chronic Disease and Adherence Challenges

Chronic conditions, such as cardiovascular disease and diabetes, cause nearly 75% of global deaths and often require long-term management. Millions of individuals struggle with regular medication intake due to various barriers. These barriers to adherence include high costs, long travel distances to pharmacies, fragmented health systems, short dispensing intervals, limited digital access, and reimbursement policies that may incentivize shorter prescription cycles.

Medicine delivery systems significantly impact treatment success. For individuals with hypertension or diabetes, missed refills have been associated with poorer disease control, increased complications, hospitalization, and mortality.

Diverse Delivery Models Examined

The review explored a range of existing and emerging delivery models:

This remains the most common delivery model globally. Patients obtain prescriptions from community or hospital pharmacies, where pharmacists provide counseling and identify drug interactions. In some high-income countries, additional services like blood pressure checks are offered. Limitations include potential disruptions to regular refills due to travel times, waiting periods, and charges.

Medications are delivered directly to homes or workplaces, often in 60- or 90-day supplies. This can reduce travel time and may improve adherence for chronic conditions. The effectiveness and cost reduction benefits vary across healthcare systems. Adherence estimates in these systems often rely on proxy measures (e.g., prescription refill coverage). Challenges include reliance on reliable postal services, potential delays, lost shipments, and issues with temperature-sensitive medicines.

These expanded significantly during the COVID-19 pandemic, combining online ordering with home delivery. Direct-to-consumer models can integrate prescribing, dispensing, and delivery within a single platform, potentially reducing medication costs by eliminating markups. Counseling must be intentionally integrated digitally, with regulatory safeguards to prevent issues like counterfeit medicines or inappropriate prescribing. Safety outcomes depend on regulatory oversight and digital literacy.

New technologies like drones, smart lockers, and automated dispensing units aim to improve access, particularly in remote areas, and reduce waiting times. Drones have been used for delivering vaccines and emergency supplies in Africa. Evidence for routine chronic disease medicine delivery via these methods is still emerging, with widespread adoption limited by cost, infrastructure, and regulatory complexity.

This model allows doctors to provide medicines directly during consultations, which can improve access in rural areas and reduce treatment delays. This practice is regulated differently across countries. Potential conflicts of interest may arise, especially in fee-for-service systems, necessitating transparent regulation.

System-Level Constraints and Policy Design

Medicine delivery models are fundamentally shaped by national funding, regulation, infrastructure, reimbursement design, and digital capacity. Public systems may prioritize equity but often face innovation challenges, while private systems may innovate rapidly but potentially inadequately serve lower-income populations. Hybrid models often encounter regulatory rigidity and limitations from existing prescribing software and reimbursement rules.

Challenges to adherence are further compounded by short dispensing intervals, high out-of-pocket costs, fragmented delivery systems, and inconsistent adherence measurement methods. The review emphasizes the critical need to differentiate between system cost efficiency and patient affordability.

Recommendations and Implications

To improve adherence to long-term chronic disease treatments, the review suggests several key actions:

• Longer prescription durations to reduce refill frequency.
• Integration of digital support with human care to provide comprehensive patient assistance.
• Alignment of financial incentives with positive patient outcomes.
• Inclusive digital transitions to ensure access for older adults, rural populations, and individuals with limited digital literacy.
• Evaluation of environmental impacts, such as packaging waste and transport emissions, to ensure sustainable practices.

The review concludes that flexible systems capable of meeting diverse patient needs, supported by strong governance, regulatory coordination, and international standardization of evidence, are critical.

Effective medicine delivery systems, which influence access, cost, and adherence, are as important as the prescribed medication itself. Strengthening delivery infrastructure, regulatory frameworks, patient-centered design, and harmonized adherence measurement can improve health outcomes globally.