1
|
Qudah B, Chewning B. Exploring the impact of a digital health tool on patients' interaction with community pharmacists: A pilot randomized controlled study. Res Social Adm Pharm 2024; 20:986-994. [PMID: 38971677 DOI: 10.1016/j.sapharm.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/13/2024] [Accepted: 06/28/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The use of digital Patient- Reported Outcomes (PRO) tools has been shown to enhance the exchange of information and shared decision-making in medical encounters. However, their influence on patient-pharmacist interactions has not yet been explored. OBJECTIVES This study aimed to examine the impact of RxTalk™, a digital PRO tool, in supporting the communication between patients and pharmacists compared to usual care. METHODS Intervention: RxTalk™ was developed to collect information about medication adherence and beliefs, using a tablet computer. STUDY DESIGN A pilot randomized controlled study was conducted at a community pharmacy in Wisconsin, USA. Sixty patients were randomized to either the intervention group who used RxTalk™ during medication pick-up or the control group who did not use the tool. Patients who used RxTalk™ received paper copies of their responses which were also shared with pharmacists. The consultation was audio-recorded for both groups and coded using the Active Patient Participation Coding scale. Follow-up phone interviews were conducted with both groups within one week of enrollment. RESULTS Patient tapes were analyzed. In the unadjusted model, patients in the intervention group had a higher active participation rate (p = 0.004) and raised significantly more concerns during consultations (p < 0.001) compared to the control group. Pharmacists asked twice as many questions while counseling patients in the intervention group compared to the control group (p < 0.001). After controlling for patients' demographics and pharmacists' questions, there was a statistical difference between the two patient groups in their odds of expressing at least one concern utterance. CONCLUSION This pilot study suggests that collecting PRO from patients with chronic illnesses and providing results to pharmacists and patients can help patients express their health and medication concerns. RxTalk™ would be useful for pharmacists who wish to improve the recognition and management of medication-related problems.
Collapse
Affiliation(s)
- Bonyan Qudah
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1685 Highland Ave, Madison, WI, 53705, USA.
| | - Betty Chewning
- Department of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI, 53705, USA
| |
Collapse
|
2
|
Wang X, He X, Zhang P, Zhang M, Ma R, Dai R, Li X. The impact of the national volume-based procurement policy on the use of policy-related drugs in Nanjing: an interrupted time-series analysis. Int J Equity Health 2023; 22:200. [PMID: 37770924 PMCID: PMC10540346 DOI: 10.1186/s12939-023-02006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND In September 2019, the "4 + 7" centralized procurement pilot program was expanded nationwide aiming at reducing drug prices by means of volume-based procurement and using accredited generic drugs for branded drug substitutes. Given the current uncertain effect of the policy outside pilot areas, this study was conducted to evaluate the impact of the National Volume-based Procurement policy on the use of policy-related drugs after expansion. METHOD A single-group interrupted time series was applied using drug purchase data, covering 25 months from December 2018 to December 2020. Drugs related to the centralized procurement policy were selected as samples, including 25 first-batch policy-related drugs and 56 alternative drugs. Centralized procured drugs can be divided into bid-winning and non-winning products, where non-winning products were sorted into generic and branded drugs, and alternative products were classified according to different degrees of substitution. Purchase volume, expenditures, and daily costs were measured. RESULTS After the implementation of the policy, a significant increase was associated with the volume of bid-winning drugs (p < 0.001) and the volume of generic and branded drugs decreased immediately. The DDDc of drugs under the same generic name significantly reduced (an instantaneous drop of bid-winning drugs by approximately 25%, 7.62 CNY for generics and 3.07 CNY for branded drugs), saving 48.2 million CNY of drug expenditures. The policy has a significant effect on the drug for the treatment of cardiovascular diseases and exerted little influence on the drug for the treatment of nervous diseases, and the substitution of generics for antitumor-branded drugs was not obvious. In addition, the procurement volume of alternative drugs appeared to be a "carry-over". CONCLUSIONS These findings indicated that the policy demonstrated positive effects in terms of price reductions and cost savings and accelerated the substitution of generics against branded drugs. The "patent cliff" for branded drugs has gradually emerged. Besides, a short-term "spillover effect" of the volume of alternative drugs was observed, requiring special attention and vigilance.
Collapse
Affiliation(s)
- Xiao Wang
- School of Health Policy and Management, Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, P.R. China, 211166
- Department of Science and Technology, Wuxi No.2 People's Hospital, Wuxi, China
| | - Xuan He
- School of Health Policy and Management, Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, P.R. China, 211166
- Wuxi Xinwu District Center for Health Promotion and Education, Wuxi, China
| | - Pei Zhang
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Mengdie Zhang
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Rui Ma
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Rouli Dai
- National Institute of Drug Clinical Trials, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, P.R. China, 211166.
- School of Pharmacy, Nanjing Medical University, Nanjing, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
| |
Collapse
|
3
|
Rainio R, Ahonen R, Lämsä E, Timonen J. Factors facilitating and hindering counselling about generic substitution and a reference price system in community pharmacies - a survey among Finnish dispensers. BMC Health Serv Res 2022; 22:1130. [PMID: 36071413 PMCID: PMC9454142 DOI: 10.1186/s12913-022-08477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pharmacies play the key role in implementing generic substitution (GS) and counselling customers about it. This study aimed to explore dispensers’ perceptions of the factors that facilitate or hinder counselling customers on GS and the reference price system (RPS) in community pharmacies. It also studied dispensers’ opinions about the benefits and problems of these systems and discusses them from the counselling point of view. Methods A postal survey was conducted among Finnish community pharmacy dispensers in spring 2018. The research questions were studied through open-ended questions and analyzed both qualitatively and quantitatively. The questions were analyzed first with inductive content analysis by two researchers independently. The responses were encoded and categorized according to the analytical framework, which was inductively developed alongside the analysis. The categorized responses were further analyzed using frequencies and percentages. Results The response rate was 50.8% (n = 498). Of the respondents, 75.9% reported factors that facilitated counselling about GS and RPS. The most commonly mentioned factors included customers’ characteristics (36.5%), the information systems used in the pharmacy (28.3%), and the features of interchangeable medicines (21.7%). Of the respondents, 89.0% reported factors that hindered counselling, of which customers’ characteristics (45.8%), the unavailability of medicines and other availability issues (32.5%), the features of interchangeable medicines (22.6%) and time pressure in the pharmacy (22.1%) were the most commonly reported. The benefits of the systems focused on cost savings for customers and society (74.4%). The most commonly reported problems concerned medicine availability (31.9%), changes in medicine prices and in reference price band (28.9%), as well as how GS is time-consuming and increases workload (24.2%). Conclusions Finnish dispensers reported more hindering than facilitating factors in GS and RPS counselling. Customers’ characteristics were the most often mentioned in both cases. Customers’ knowledge could be increased by providing information and education. However, developing simpler regulations for GS and RPS, intelligent assisting software, and solutions for secured medicine availability would facilitate implementation of GS. Simplified price counselling would also guarantee the time needed and focus on instructions on the correct and safe use of medicines. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08477-2.
Collapse
Affiliation(s)
- Riikka Rainio
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland.
| | - Riitta Ahonen
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
| | - Elina Lämsä
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
| | - Johanna Timonen
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
| |
Collapse
|
4
|
|
5
|
Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
Collapse
Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|
6
|
Godman B. Ongoing initiatives to improve the prescribing of medicines across sectors and the implications. ADVANCES IN HUMAN BIOLOGY 2020. [DOI: 10.4103/aihb.aihb_90_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Rainio R, Ahonen R, Timonen J. The content of patient counseling about interchangeable medicines and generic substitution in Finnish community pharmacies - a survey of dispensers. BMC Health Serv Res 2019; 19:956. [PMID: 31829174 PMCID: PMC6907127 DOI: 10.1186/s12913-019-4798-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Generic substitution aims to increase the use of more affordable generic preparations and restrain the growth of medicine expenditures. Pharmaceutical staff plays an important role in generic substitution by implementing substitution and counseling customers. The aim of this study was to explore how Finnish dispensers inform pharmacy customers about interchangeable medicines and generic substitution and what customers ask dispensers about generic substitution and the reference price system. Methods A questionnaire was sent to a random sample of dispensers (n = 1054) working in community pharmacies in spring 2018. The data was analyzed using frequencies, percentages and the Chi-square test and Fisher’s exact test. The open-ended questions were analyzed first using inductive content analysis and later with the quantitative methods mentioned above. Results The final study material consisted of 498 questionnaires (response rate 51%). The main topics dispensers always informed customers about were the physician’s record in the prescription not to substitute the medicine (69%) and that the prescribed or purchased interchangeable medicine did not belong in the reference price band (59%). Topics mentioned often by dispensers dealt with customer’s chance to choose their medicine from among several alternative products (68%) and the manufacturer of the interchangeable medicines (66%). Differences in appearance (33%) or in composition (28%) of interchangeable products were the most common topics mentioned only when the customer asked about them. Of the respondents 17.6% always and 51.4% often informed the customer about the least expensive interchangeable product at the point of dispensing. Customers’ questions about the generic substitution and reference price system most commonly (82.4%) concerned the similarity of interchangeable medicines. Conclusions Finnish dispensers provide customers with a wide range of information about different subjects when dispensing interchangeable medicines. Patient counseling generally meets the legislative requirements, except for price counseling. In future, information about generic substitution and interchangeable medicines should continuously be provided to customers both at pharmacies and elsewhere, e.g. through educational campaigns.
Collapse
Affiliation(s)
- Riikka Rainio
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland.
| | - Riitta Ahonen
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland
| | - Johanna Timonen
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland
| |
Collapse
|
8
|
Tolonen HM, Airaksinen MS, Ruokoniemi P, Hämeen-Anttila K, Shermock KM, Kurki P. Medication safety risks to be managed in national implementation of automatic substitution of biological medicines: a qualitative study. BMJ Open 2019; 9:e032892. [PMID: 31662405 PMCID: PMC6830661 DOI: 10.1136/bmjopen-2019-032892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To explore relevant Finnish stakeholders' perceptions on the automatic substitution of biological medicines with particular focus on medication safety and issues that need to be considered to create an appropriate model for automatic biological product substitution. DESIGN Qualitative interview study. METHODS Data were collected in semistructured individual (n=17), pair (n=7) and group (n=8) interviews (32 interviews, 62 participants) in 2018. Participants represented a wide range of stakeholders involved in the pharmacotherapy process: community pharmacists (n=8 interviews), authorities (n=7), prescribers (n=7), pharmaceutical industry and wholesalers (n=6), patients/customers (n=2), hospital pharmacists (n=1) and nurses (n=1). Inductive content analysis was performed. RESULTS Benefits of automatic substitution were identified as cost savings, more patients receiving biological treatments and enhanced continuity of treatment. Six major risk categories were identified: (1) the patient's medication is interrupted or complicated temporarily or permanently, (2) the patient uses two products with the same active substance, (3) the traceability of the product is compromised, (4) the patient cannot get into healthcare in case of problems, (5) the patient does not receive substitution-related advice from a pharmacy and (6) the patient is distracted by the support material he/she receives. Several risk mitigation measures were commonly mentioned: medication and device counselling by pharmacists (n=23), infrequent substitution interval (n=15) and better knowledge on biosimilars among healthcare providers (n=13). CONCLUSION Automatic substitution of biologics is associated with risks that should be prospectively managed before implementing the procedure. The substitution also introduces new tasks and communication needs to those involved in actual medication use process, particularly to community pharmacists who will be responsible for substitution and counselling the patients.
Collapse
Affiliation(s)
- Hanna M Tolonen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- HUS Pharmacy, Helsinki University Hospital, Helsinki, Finland
| | - Marja Sa Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | | | | | - Kenneth M Shermock
- Center for Medication Quality and Outcomes, The Johns Hopkins Health System, Baltimore, Maryland, USA
- Center for Drug Safety and Effectiveness, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | |
Collapse
|
9
|
Souliotis K, Golna C, Kani C, Markantonis S. Exploring knowledge and perceptions on generic drugs of final year pharmacy school students in Greece. Expert Rev Pharmacoecon Outcomes Res 2019; 19:569-574. [PMID: 30658041 DOI: 10.1080/14737167.2019.1571412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The economic crisis in Greece has triggered an extensive public debate about the use of generic drugs (generics). Despite their cost-saving potential, generic market penetration remains very low. This raises questions on awareness of, perception on and preference for generics by health-care professionals and patients. This is a descriptive study on the level of knowledge and attitudes towards generics of final year pharmacy school students in Greece. Methods: An electronic questionnaire was distributed to 173 senior pharmacy school students in three Universities in Greece. Responses were submitted electronically. Results: The majority of students knew that generics contain the same active ingredient as the originator products and are cheaper. Students were somehow concerned with safety and efficacy of generics. The majority of students agreed that pharmacists should probably recommend the use of generics, and indicated that prescribing and dispensing practices would largely depend on the profit margin. Despite more than half of the students expressing a positive attitude towards generics, they were inadequately educated on their features. Conclusion: It is critical to improve knowledge of and preference for generics amongst health-care professionals from early on if to build the trust required to increase generic market penetration and achieve measurable savings in pharmaceutical expenditure.
Collapse
Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece.,Health Policy Institute , Athens , Greece
| | | | - Chara Kani
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece
| | - Sophia Markantonis
- Department of Pharmacy, National and Kapodistrian University of Athens , Athens , Greece
| |
Collapse
|
10
|
Olsson E, Svensberg K, Wallach-Kildemoes H, Carlsson E, Hällkvist C, Kaae S, Sporrong SK. Swedish patients' trust in the bioequivalence of interchangeable generics. What factors are important for low trust? Pharm Pract (Granada) 2018; 16:1298. [PMID: 30637031 PMCID: PMC6322990 DOI: 10.18549/pharmpract.2018.04.1298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/10/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Generic substitution (GS), is a cost-containment strategy meant to contain
pharmaceutical expenditure without compromising health objectives. In order
to shape GS into a policy that is both efficient and safe it is crucial to
understand which factors are most important for patients’ trust in
GS. Objective: To assess Swedish patients’ level of trust in the bioequivalence of
cheap and expensive generic medicines, and the association between trust and
various factors. Methods: A cross-sectional study was conducted. Questionnaires were handed out at 12
community pharmacies in Sweden, selected through stratified sampling,
between March and April 2015. The questionnaire included seven
socio-demographic questions in addition to 18 items divided into three
sections: the ‘views on generic medicine’-scale, information
on and prior experiences of GS, financial aspects and change of color/name.
Odds Ratios (ORs) were estimated applying adjusted logistic regression
analyses with trust in the bioequivalence of generic medicines used as
outcome variable and various factors as predictors. Results: A total of 719 patients participated (response rate 85.7%). The
results show that 70.7% of the respondents’ trust that cheap
and expensive interchangeable generic medicines are equal. Of the
respondents 36.0% considered the change in appearance and
40.8% the change in names to complicate adherence. Lower trust in the
bioequivalence of generic medicines were associated with being female
(aOR=1.82, 95%CI 1.20:2.75, p<0.01), patients perceiving that
changes in product name and appearance make adherence more complicated
(aOR=2.18, 95%CI 1.48:3.19, p<0.001), disagreeing in that GS
saves money for me (the customer) (aOR=2.68, 95%CI 1.58:4.55,
p<0.001) or that GS saves money for society (aOR=3.21, 95%CI
1.46:7.08, p<0.01). Conclusions: Seven out of ten respondents had trust in the bioequivalence of generic
medicines, and one in three considered GS to complicate adherence. Four
factors were associated with lower trust in GS, i.e. female gender, agreeing
that changes in product name and appearance complicates adherence,
disagreeing in that GS saves money for me or disagreeing in that GS saves
money for the society. Low trust in GS needs to be addressed, not least in
the communication between health professionals and patients.
Collapse
Affiliation(s)
- Erika Olsson
- Department of Pharmacy, Unit for Social and Clinical Pharmacy, University of Copenhagen. Copenhagen (Denmark).
| | - Karin Svensberg
- Department of Pharmacy, PharmaSafe Research Group, School of Pharmacy, University of Oslo, Oslo (Norway).
| | - Helle Wallach-Kildemoes
- Department of Pharmacy, Unit for Social and Clinical Pharmacy, University of Copenhagen. Copenhagen (Denmark).
| | - Emma Carlsson
- Department of Pharmacy, Uppsala Biomedical Centre, Uppsala University. Uppsala (Sweden).
| | - Caroline Hällkvist
- Department of Pharmacy, Uppsala Biomedical Centre, Uppsala University. Uppsala (Sweden).
| | - Susanne Kaae
- Department of Pharmacy, Unit for Social and Clinical Pharmacy, University of Copenhagen. Copenhagen (Denmark).
| | - Sofia Kälvemark Sporrong
- Department of Pharmacy, Unit for Social and Clinical Pharmacy, University of Copenhagen. Copenhagen (Denmark).
| |
Collapse
|
11
|
Niaz Q, Godman B, Massele A, Campbell S, Kurdi A, Kagoya HR, Kibuule D. Validity of World Health Organisation prescribing indicators in Namibia’s primary healthcare: findings and implications. Int J Qual Health Care 2018; 31:338-345. [DOI: 10.1093/intqhc/mzy172] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/03/2018] [Accepted: 07/26/2018] [Indexed: 12/18/2022] Open
Abstract
Abstract
Objective
World Health Organization/International Network of Rational use of Drugs (WHO/INRUD) indicators are widely used to assess medicine use. However, there is limited evidence on their validity in Namibia’s primary health care (PHC) to assess the quality of prescribing. Consequently, our aim was to address this.
Design, setting, participants and interventions
An analytical cross-sectional survey design was used to examine and validate WHO/INRUD indicators in out-patient units of two PHC facilities and one hospital in Namibia from 1 February 2015 to 31 July 2015. The validity of the indicators was determined using two-by-two tables against compliance to the Namibian standard treatment guidelines (NSTG). The receiver operator characteristics for the WHO/INRUD indicators were plotted to determine their accuracy as predictors of compliance to agreed standards. A multivariate logistic model was constructed to independently determine the prediction of each indicator.
Main outcomes and results
Out of 1243 prescriptions; compliance to NSTG prescribing in ambulatory care was sub-optimal (target was >80%). Three of the four WHO/INRUD indicators did not meet Namibian or WHO targets: antibiotic prescribing, average number of medicines per prescription and generic prescribing. The majority of the indicators had low sensitivity and/or specificity. All WHO/INRUD indicators had poor accuracy in predicting rational prescribing. The antibiotic prescribing indicator was the only covariate that was a significant independent risk factor for compliance to NSTGs.
Conclusion
WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.
Collapse
Affiliation(s)
- Q Niaz
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - B Godman
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - A Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - S Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Institute of Population Health. University of Manchester, Manchester
| | - A Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - H R Kagoya
- Monotiring and Evaluation Unit, Management Sciences for Health, Windhoek-Namibia
| | - D Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| |
Collapse
|