title: Why does increasing public access to medicines differ between countries? Qualitative comparison of nine countries.
abstract: OBJECTIVE
  To identify factors associated with differences between developed countries in reclassifying (switching) medicines from prescription to non-prescription availability.
  
  
  METHODS
  Cross-national qualitative research using a heuristic approach in the US, UK, Japan, Australia and New Zealand, supplemented by data from Canada, Denmark, the Netherlands and Singapore. In-depth interviews with 80 key informants (65 interviews) explored and compared factors in terms of barriers and enablers to reclassification of medicines in each country. Document analysis supplemented interview data.
  
  
  RESULTS
  Each country had a unique mix of enablers and barriers to reclassification. Enablers included government policy (particularly in UK), pharmacist-only scheduling (particularly in Australia and New Zealand) and large market size (particularly in the US and Europe). Local barriers included limited market potential in small countries, the cost of a reclassification (particularly in the US), competition from distributors of generic medicines, committee inconsistency and consumer behavior. UK had more enablers than barriers, whereas in Australia the opposite was true.
  
  
  CONCLUSIONS
  Different factors limit or enable reclassification, affecting consumer access to medicines in different countries. For countries attempting to reduce barriers to reclassification, solutions may include garnering government support for reclassification, support and flexibility from the medicines regulator, having a pharmacy-only and/or pharmacist-only category, providing market exclusivity, ensuring best practice in pharmacy, and minimizing the cost and delays of reclassification.
authors.affiliation: Honorary Research Fellow, Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand n.gauld@auckland.ac.nz.
authors.forename: Natalie
authors.initials: N
authors.lastname: Gauld
authors.affiliation: Honorary Research Fellow, Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
authors.forename: Linda
authors.initials: L
authors.lastname: Bryant
authors.affiliation: Associate Professor, School of Pharmacy, Faculty of Health Sciences, Curtin University, Perth, Australia.
authors.forename: Lynne
authors.initials: L
authors.lastname: Emmerton
authors.affiliation: Senior Lecturer, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Kelly
authors.affiliation: Professor, School of Pharmacy, Hokkaido Pharmaceutical University, Otaru, Japan.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Kurosawa
authors.affiliation: Associate Professor, Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Buetow
mesh_terms: D003157:Community Pharmacy Services; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D004366:Nonprescription Drugs; D012651:Self Medication
chemical_list: D004366:Nonprescription Drugs
keywords: access to medicines; community pharmacy services; health policy; nonprescription drugs; self-medication