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Mavela NH, Couchman IMS, Mgwaba T, Nxumalo CT. A qualitative study of pharmacists' perceptions and awareness of homoeopathic medicines in Durban, South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e10. [PMID: 38197691 PMCID: PMC10784278 DOI: 10.4102/safp.v65i1.5698] [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: 12/19/2022] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND There is growing interest in the demand for and use of homoeopathic medicines by the public; however, little is known about the perspectives of pharmacists regarding the use of these medicines, particularly in the South African private health context. METHODS A qualitative approach using an exploratory cross-sectional descriptive design was used. Data were collected from a purposive sample of 15 participants comprising pharmacy managers, pharmacists and pharmacy assistants from six different conveniently selected private pharmacy retail outlets. Data were collected using individual interviews utilising a semi-structured interview guide. An audiotape was used to record the data which were transcribed verbatim and analysed thematically, following Tech's steps of data analysis. Ethical approval to conduct the study was obtained from the Durban University of Technology's Institutional Research Ethics Committee. RESULTS The findings of this study revealed four superordinate themes related to pharmacists' perceptions and self-reported awareness regarding homoeopathic medicines. These are (1) negative perceptions regarding homoeopathic medicines, (2) perceived benefits of homoeopathic medicines, (3) poor knowledge and awareness of homoeopathic medicines and (4) capacity development and curriculum aspects. CONCLUSION The findings highlight the need for an educational intervention on homoeopathic medicines targeting pre-service and in-service pharmacy practitioners, to enable them to provide effective education regarding all types of medicines as the demand for homoeopathic medicines increases.Contribution: The study findings provide evidence to support advocacy for an educational intervention to improve awareness and knowledge of pharmacists to enable provision of effective health education for patients. More research, however, is required to inform the contents of this training intervention for pharmacists.
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Affiliation(s)
- Nokuthula H Mavela
- Centre for Excellence in Learning and Teaching, Durban University of Technology, Durban.
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Koushki MS, Goudarzi R, Amiresmaili M, Nekooei Moghaddam M, Yazdi-Feyzabadi V, Talebian A. Strategies of drugs cost containment in hospital: A systematic literature review. Int J Health Plann Manage 2023; 38:7-21. [PMID: 36100961 DOI: 10.1002/hpm.3542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In recent years, the world's health system faces with increasing trend of costs. In this regard, Hospital is one of the environments that consumes a large share of the total expenditure of the health system. Medications are one of the most expensive components in hospitals, which require appropriate measurements to control and reduce costs. The present systematic review was conducted to identify strategies and actions for cost containment in hospital. METHOD Using the PRISMA protocol, a systematic review of the texts was performed to identify strategies and actions for reducing drug cost. In this systematic review, the selected keywords were searched in the following databases: web of sciences, Scopus, PubMed, Google Scholar, and Embase. The inclusion criteria included English-language articles, hospital-level studies, and those studies performed on reducing and controlling hospital costs. The exclusion criteria also included the followings: primary health care studies, non-English language studies, health system studies, and studies solely focussed on the cost-effectiveness of a particular drug. The quality of these articles was investigated using the checklist adapted and modified in the present study. RESULTS A total of 4696 articles were identified from the reviewed databases and 26 articles were identified from some other sources. After removing duplicate studies and reviewing the title, summary, and full text of articles using reference check and supplemental search, 21 articles were finally included. A number of strategies or managerial actions were extracted from the final articles. According to the qualitative results, qualitative meta-synthesis was used and after eliminating duplicate solutions, the data were classified into five groups: procurement, storage, distribution, prescription, and use. CONCLUSION According to the increasing cost of medicines, some hospital managers now attempt to reduce hospital costs using drug chain management. Drug cost reduction strategies can be applied for any component of drug chain management such as procurement, storage, distribution, prescription, and use. Also, proper implementation of these strategies and rationalisation of drug use will result in more efficiency of the hospital.
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Affiliation(s)
- Mohammad-Saleh Koushki
- PhD Student in Health Services Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Goudarzi
- Assistant Professor in Health Economic, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadreza Amiresmaili
- Professor in Health Services Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmoud Nekooei Moghaddam
- Professor in Health Services Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Yazdi-Feyzabadi
- Assistant Professor in Health Policy, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Talebian
- Department of Medical Library and Information, School of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Koduah A, Baatiema L, de Chavez AC, Danso-Appiah A, Kretchy IA, Agyepong IA, King N, Ensor T, Mirzoev T. Implementation of medicines pricing policies in sub-Saharan Africa: systematic review. Syst Rev 2022; 11:257. [PMID: 36457058 PMCID: PMC9714131 DOI: 10.1186/s13643-022-02114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA) are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability; however, evidence on the experiences of implementations of these policies in SSA settings appears limited. Therefore, to bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? METHODS We identified policies and examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction, and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines. RESULTS Of the 5595 studies identified, 31 met the inclusion criteria. The results showed thirteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were limited awareness about policies, lack of regulatory capacity and lack of price transparency in external reference pricing process. Key facilitators were favourable policy environment on essential medicines, strong political will and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines was mixed. Reductions in prices were reported occasionally, and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines. CONCLUSIONS Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications, for SSA and potentially other low-resource settings: avoiding a 'one-size-fits-all' approach, engaging both private and public sector policy actors in policy implementation and continuously monitoring implementation and effects of policies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178166.
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Affiliation(s)
- Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Leonard Baatiema
- Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Anna Cronin de Chavez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Timothy Ensor
- Nuffield Centre for International Health, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Siagian RC, Ayuningtyas D, Soewondo P, Thabrany H, Achadi A, Bachtiar NS. Assessment of country readiness for drug development: A qualitative study in Indonesia. WORLD MEDICAL & HEALTH POLICY 2021. [DOI: 10.1002/wmh3.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ria C. Siagian
- Biological Products Registration Badan Pengawas Obat dan Makanan Jakarta Indonesia
| | - Dumilah Ayuningtyas
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Prastuti Soewondo
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Hasbullah Thabrany
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Anhari Achadi
- Department of Health Policy and Administration Faculty of Public Health Universitas Indonesia Depok Jawa Barat Indonesia
| | - Novilia S. Bachtiar
- Surveillance and Clinical Trial Division PT. Bio Farma Bandung West Java Indonesia
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Ferdiana A, Liverani M, Khan M, Wulandari LPL, Mashuri YA, Batura N, Wibawa T, Yeung S, Day R, Jan S, Wiseman V, Probandari A. Community pharmacies, drug stores, and antibiotic dispensing in Indonesia: a qualitative study. BMC Public Health 2021; 21:1800. [PMID: 34620152 PMCID: PMC8499417 DOI: 10.1186/s12889-021-11885-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. METHODS In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. RESULTS A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement. CONCLUSIONS Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.
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Affiliation(s)
- Astri Ferdiana
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Faculty of Medicine, Universitas Mataram, Mataram, Indonesia
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK. .,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan. .,Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | - Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,Aga Khan University, Karachi, Pakistan
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Faculty of Medicine, Universitas Udayana, Bali, Indonesia
| | - Yusuf Ari Mashuri
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Tri Wibawa
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Microbiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Shunmay Yeung
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Day
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia
| | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.,The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Ari Probandari
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
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Anggriani Y, Ramadaniati HU, Sarnianto P, Pontoan J, Suryawati S. The Impact of Pharmaceutical Policies on Medicine Procurement Pricing in Indonesia Under the Implementation of Indonesia's Social Health Insurance System. Value Health Reg Issues 2019; 21:1-8. [PMID: 31634791 DOI: 10.1016/j.vhri.2019.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/26/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Indonesia's social health insurance (Jaminan Kesehatan Nasional, JKN) has been implemented since 2014. To support medicine provision, the government launched policies reform on medicine pricing, procurement and reimbursement; hence, the system might affect medicine prices in the country. OBJECTIVE To evaluate the effects of the pharmaceutical policies reforms on medicine procurement prices. METHODS This was a pre-post observational study. Medicine price data were collected retrospectively from the 2013 Ministry of Health procurement price list, the 2017 e-catalogue procurement system, and the procurement departments at 2 hospitals in Jakarta and Cilegon (both categorized as region I). The 2013 national procurement price was compared with the 2017 e-catalogue price. The hospitals' procurement prices were collected from the data 3 years before and 3 years under Indonesia's social health insurance JKN (2011-2016), and the data were used to assess the medicine procurement prices in real conditions. The outcome measure was the difference in procurement prices before and under the JKN. RESULTS The results showed that the procurement prices of 429 (79.6%) of 539 medicines listed in the 2017 e-catalogue decreased, of which 210 items (39.0%) showed over a 50% decrease. Nevertheless, the procurement prices of 104 items (19.3%) increased, especially those that were still under patent or those with a few brands registered in Indonesia. The procurement prices in public and private hospitals showed a similar trend, that is, a significant decrease. Interestingly, non-e-catalogue medicine prices also decreased quite steeply, although the prices of the branded generic category in the private hospital remained unchanged. CONCLUSION The pharmaceutical policies under the JKN implementation had a profound impact on decreasing medicine procurement prices in Indonesia.
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Affiliation(s)
- Yusi Anggriani
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia.
| | - Hesty Utami Ramadaniati
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia
| | - Prih Sarnianto
- Faculty of Pharmacy, University of Pancasila, Jl. Srengseng Sawah, Jagakarsa, Jakarta Selatan, Indonesia
| | - Jenny Pontoan
- National Institute of Science and Technology, Jakarta, Indonesia
| | - Sri Suryawati
- Division of Clinical Pharmacology and Medicine Policy, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Abdel Rida N, Mohamed Ibrahim MI, Babar Z. Pharmaceutical pricing policies in Qatar and Lebanon: narrative review and document analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abdel Rida N, Mohamed Ibrahim MI, Babar ZUD, Owusu Y. A systematic review of pharmaceutical pricing policies in developing countries. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Yaw Owusu
- College of Pharmacy; Qatar University; Doha Qatar
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