title: Widening consumer access to medicines through switching medicines to non-prescription: a six country comparison.
abstract: BACKGROUND
  Switching or reclassifying medicines with established safety profiles from prescription to non-prescription aims to increase timely consumer access to medicines, reduce under-treatment and enhance self-management. However, risks include suboptimal therapy and adverse effects. With a long-standing government policy supporting switching or reclassifying medicines from prescription to non-prescription, the United Kingdom is believed to lead the world in switch, but evidence for this is inconclusive. Interest in switching medicines for certain long-term conditions has arisen in the United Kingdom, United States, and Europe, but such switches have been contentious. The objective of this study was then to provide a comprehensive comparison of progress in switch for medicines across six developed countries: the United States; the United Kingdom; Australia; Japan; the Netherlands; and New Zealand.
  
  
  METHODS
  A list of prescription-to-non-prescription medicine switches was systematically compiled. Three measures were used to compare switch activity across the countries: "progressive" switches from 2003 to 2013 (indicating incremental consumer benefit over current non-prescription medicines); "first-in-world" switches from 2003 to 2013; and switch date comparisons for selected medicines.
  
  
  RESULTS
  New Zealand was the most active in progressive switches from 2003 to 2013, with the United Kingdom and Japan not far behind. The United States, Australia and the Netherlands showed the least activity in this period. Few medicines for long-term conditions were switched, even in the United Kingdom and New Zealand where first-in-world switches were most likely. Switch of certain medicines took considerably longer in some countries than others. For example, a consumer in the United Kingdom could self-medicate with a non-sedating antihistamine 19 years earlier than a consumer in the United States.
  
  
  CONCLUSIONS
  Proactivity in medicines switching, most notably in New Zealand and the United Kingdom, questions missed opportunities to enhance consumers' self-management in countries such as the United States.
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Gauld
authors.affiliation: School of Pharmacy, University of Auckland, Auckland, New Zealand; Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Fiona S
authors.initials: FS
authors.lastname: Kelly
authors.affiliation: Hokkaido Pharmaceutical University School of Pharmacy, Otaru, Hokkaido, Japan.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Kurosawa
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
authors.forename: Linda J M
authors.initials: LJ
authors.lastname: Bryant
authors.affiliation: School of Pharmacy, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Emmerton
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Buetow
mesh_terms: D001315:Australia; D018166:Health Care Reform / Q000379:methods* / Q000639:trends; D006801:Humans; D007564:Japan; D008511:Medicine / Q000379:methods* / Q000639:trends; D009313:National Health Programs / Q000639:trends; D009426:Netherlands; D009520:New Zealand; D004366:Nonprescription Drugs / Q000191:economics / Q000627:therapeutic use*; D055553:Prescription Drugs / Q000191:economics / Q000627:therapeutic use*; D006113:United Kingdom; D014481:United States
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs