Browsing by Author "Awad, Camila"

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    Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review
    (2022) Castillo-Laborde, Carla; Hirmas Adauy, Macarena; Matute, María Isabel; Jasmen, Anita; Urrejola, Oscar; Molina, Xaviera; Awad, Camila; Frey, Catalina; Pumarino, Sofia; Descalzi, Fernando; Ruiz, Tomás; Plass, Barbara
    Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients' education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers' role bringing medicines closer; and patients' health education and disease management.
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    HABIT: Heparin and Aspirin on Birth in Inherited Thrombophilia, an International Multicenter Phase IIb Randomized Triple Blinded Clinical Trial
    (2023) Carvalho, Alessandra; Awad, Camila; Gallucci, Alessia; Flores, Ana; La Riva, Anibal; Díaz, Daniel; Da Silva, Deivid; Saraceno, Taylor; Rivera, Oswaldo; Fricke, Stephan; Garcia, Regina; Zhou, Steven; Bazan, María; Castellaro, María; Alencar, Luiza; Blanco, Pedro; Teixeira, Eliluane; Gonçalves, Roberta; Etchebehere, Priscila; Gonzalez, Jessica; Abdallah, Tasneem; Hamad, Malaz; Ahmed, Shiema; Méndez, Paola; Faisal, Saif; Robladillo, Devy; Gutiérrez, Judith; Guidetti, Matteo; Abu, Nebal
    Introduction: In pregnant women with inherited thrombophilia (IT) and recurrent pregnancy loss, there is no higher-level evidence proving the beneficial effects of anticoagulation or platelet inhibition in preventing miscarriages. We hypothesize that anticoagulation with low molecular weight heparin (LMWH) and/or platelet aggregation inhibition with aspirin will increase the proportion of live birth in this population. Methods: In this phase IIb, factorial, randomized, triple blinded, placebo-controlled (double dummy) clinical trial, pregnant women aged 18 to 40 with a history of IT and 2 or more previous miscarriages, will be randomized and stratified by age and number of miscarriages in a 2x2 factorial design will be allocated equally to one of the four arms. The primary outcome of live birth will be analyzed through logistic regression analysis, controlling for strata, and results will be reported as odds ratio (OR) and 95% confidence intervals (CIs). Similarly, the secondary outcomes will include pregnancy loss, maternal mortality, major bleeding events, medication-associated adverse events, placental abruption, preterm birth, and gestational age at delivery. We will perform subgroup analysis for smoking status, weight, age, number of miscarriages, and type of thrombophilia. Discussion: There is lack of evidence for the use of anticoagulants to prevent pregnancy loss in women with inherited thrombophilia, despite the common diverging prescribing practice predominantly extrapolated from observations in acquired thrombophilia. We aim to provide an evidence base to create a standard of care in cases of recurrent pregnancy loss in women with IT.
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    La ruta del medicamento en Chile
    (2022) Castillo, Carla; Aguilera, Ximena; Matute, Isabel; Aguilera, Ximena; Awad, Camila; Castillo, Carla; González Wiedmaier, Claudia; Hirmas, Macarena; Matute, Isabel; Olea, Andrea
    Ruta del medicamento en Chile: principales actores, instituciones y procesos relacionados con el acceso a medicamentos. El presente documento se propone abordar el acceso a los medicamentos desde una mirada de los procesos, instituciones y actores relacionados, describiendo y analizando el camino que recorren, desde que se producen o importan, hasta su consumo por parte de la población.

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