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Noor MN, Rahman-Shepherd A, Khan SS, Hasan R, Siddiqui AR, Azam I, Bhutto F, Isani AK, Siddiqi S, Khan RI, Shakoor S, Khan M. What happens when private general practitioners receive incentivisation offers from pharmaceutical sales representatives? A qualitative study in Pakistan. J Health Serv Res Policy 2024; 29:173-181. [PMID: 38300120 DOI: 10.1177/13558196241230853] [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] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Pharmaceutical incentivisation of physicians for profit maximisation is a well-documented health system challenge. This study examined general practitioners' (GPs) reactions to pharmaceutical incentivisation offers in one region in Pakistan. METHODS We used the Standardised Pharmaceutical Sales Representative (SPSR) method and qualitative interviews with GPs. SPSRs were field researchers representing mock pharmaceutical companies who recorded their observations of 267 GPs' responses to pharmaceutical incentivisation offers. We triangulated SPSR data using qualitative interviews with a subset of the same GPs to gather information about how they interpreted different interaction outcomes. RESULTS We found four major outcomes for GPs being offered incentives by pharmaceutical companies for prescribing medications. GPs might agree to make incentivisation deals, reject incentivisation offers, disallow PSRs to access them, or remain indeterminate with no clear indication of acceptance or rejection of incentivisation offers. GPs rejecting SPSRs' incentivisation offers indicated having active commitments to other pharmaceutical companies, not being able to work with unheard-of companies, and asking SPSRs to return later. CONCLUSIONS The GP-pharmaceutical sales representative interaction that centres on profit-maximisation is complex as offers to engage in prescribing for mutual financial benefit are not taken up immediately. The SPSR method helps understand the extent of distortion of practices impacted by incentivisation. Such an understanding can support the development of strategies to control unethical behaviours.
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Affiliation(s)
- Muhammad Naveed Noor
- Assistant Professor, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Afifah Rahman-Shepherd
- Research Fellow, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sabeen Sharif Khan
- Research Coordinator, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Rumina Hasan
- Professor, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Iqbal Azam
- Assistant Professor, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Faiza Bhutto
- Director Complaints, Sindh Healthcare Commission, Karachi, Pakistan
| | | | - Sameen Siddiqi
- Professor, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robyna Irshad Khan
- Associate Professor, Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Associate Professor, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Mishal Khan
- Professor, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Kuceki G, Snyder AM, Hopkins ZH, Secrest AM. A survey of United States dermatologists' knowledge, attitudes, and practices with intramuscular triamcinolone. Arch Dermatol Res 2023; 315:1995-2002. [PMID: 36871253 DOI: 10.1007/s00403-023-02596-4] [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: 12/25/2022] [Revised: 12/25/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
Since the 1970s, intramuscular triamcinolone (IMT) has been available as an option for systemic corticosteroid use in dermatology. Although shown to be safe and effective in early studies, this method of systemic corticosteroid delivery fell out of favor in the 1980s in many United States residency programs. To identify factors associated with US dermatologists' preferences for and use of IMT we surveyed a random sample of US board-certified dermatologists to assess knowledge, attitudes, and practices regarding IMT in dermatologists' daily clinical practice. A total of 844 out of 2000 dermatologists completed the survey (42.2%). Only 55.0% reported feeling comfortable using IMT for steroid-responsive dermatoses, while 90.4% felt comfortable using oral corticosteroids for steroid-responsive dermatoses. Most participants (59.2%) did not prefer IMT over oral corticosteroids when both were indicated. One third (33.3%) of the participants reported that none of the faculty during their residency advocated using IMT. Receiving education on IMT indications (OR = 1.96 [95% CI: 1.46-2.63]) and encouragement to use IMT (OR = 4.29 [95% CI: 3.01-6.11]) during residency were positively associated with use of IMT at least once a month in current practice. Current knowledge, attitudes, and practices surrounding IMT vary amongst practicing dermatologists. Modifiable factors such as training could improve comfort with use of this short-term systemic steroid treatment modality.
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Affiliation(s)
- Guilherme Kuceki
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA
| | - Ashley M Snyder
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Zachary H Hopkins
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA
| | - Aaron M Secrest
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA.
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
- Department of Dermatology, Canterbury District Health Board, Health New Zealand, Christchurch, New Zealand.
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Chest Drainage Therapy: What Comes out of Pandora's Box Can Affect Patient Outcomes. J Clin Med 2022; 11:jcm11185311. [PMID: 36142958 PMCID: PMC9500716 DOI: 10.3390/jcm11185311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/29/2022] [Accepted: 09/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Over the last 100 years, the original three-bottle chest drainage system has been variously engineered into compact disposables and electronic units. Clinicians are now surrounded by a plethora of different types of systems, but little is known about the way that they work and perform. Thus, we sought to test the performance of the most commonly used chest drainage units under conditions that are relevant to clinical practice. Methods: A pleural space environment simulator was built. Thirty-two units were tested under four clinical scenarios: air leak interpretation during quiet breathing and after obstructed inspiration (−5 to −150 cmH2O), a buildup of negative pressure (−100 cmH2O), a bronchopleural fistula (10 L/min) and the need for effective external suction in the presence of air leakage. Twenty-five units were “traditional” thoracic drainages, five were “digital” low-flow/low-vacuum pumps and two were hybrids (a combination of the two). According to the design of the seal and of the suction control, the units were classified as wet-wet, wet-dry and dry-dry. Results: All wet units showed reverse air flow, with the potential to mimic an air leak when there was none. Ten wet units showed no automatic negative pressure relief features, while five dry-dry did but were slow to react. Ten wet and five dry-dry units showed no capability to handle a 10 L/min leak, as they were restrictive to flow (peak pressure up to 55 cmH2O). Only seven dry-suction units were able to maintain the set suction at high airflow rates (>20 L/min). Conclusions: Different chest drainage unit designs lead to different performances, some of which may negatively impact patient outcomes. This sounds the call to tailor our clinical practice for the individual patient. A paradigm shift to better understand all components of pleural physiology post-surgical intervention on this relatively neglected topic is needed to improve our daily practice.
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Ali KE, Naser AY, Al-Rousan R, Alwafi H, AbuAlhommos AK, Alsairafi ZK, Salawati EM, Samannodi M, Dairi MS. The attitude and acceptability towards medical promotional tools and their influence on physicians' prescribing practices in Jordan and Iraq: a cross-sectional study. BMC Health Serv Res 2022; 22:105. [PMID: 35078461 PMCID: PMC8790844 DOI: 10.1186/s12913-022-07525-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pharmaceutical companies spend more than one-third of their sales revenue on marketing and promotion directed toward healthcare professionals. There has been a focus on the relationship between healthcare professionals and the pharmaceutical industry in recent years. This study aims to explore the attitude toward and acceptability of medical promotional tools and their influence on physicians’ prescribing practices in Jordan and Iraq. Methods A cross-sectional survey study was conducted to explore the influence of visits by medical representatives (MRs) and medical promotions on physicians’ prescribing practices between June and October 2020 in Jordan and Iraq. Previously validated questionnaires were used. Results A total of 801 physicians completed the questionnaires. Face-to-face visits, followed by the dispensing of medical samples, were the two most common promotional methods used by MRs. 48% of participating physicians reported that they would accept the promotional marketing tools offered to them. MRs focused on the key selling points of their product during medical promotions, and 39.6% of the physicians reported that MRs had a negative attitude toward their competitors’ products. 69.9% of the physicians reported that they would change their practice after participating in conferences or meetings. Conclusion Medical promotional tools have a clear influence on physicians’ prescribing practices in Jordan and Iraq. Therefore, medical promotion should be controlled and guided by clear and country-specific ethical guidelines. This will ensure safe medical promotion to physicians and optimise the healthcare practices provided to patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07525-1.
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Affiliation(s)
- Karrar Ehsan Ali
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.,Inpatient pharmacy department, General Hospital in Al Diwaniyah, Al Qadisiyah, Al Diwaniyah, Iraq
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Rabaa Al-Rousan
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura university, Mecca, Saudi Arabia
| | - Amal Khaleel AbuAlhommos
- Pharmacy Practice Department, Clinical Pharmacy College, King Faisal University, Alhasa, Al Hofuf, Saudi Arabia
| | | | - Emad M Salawati
- Family medicine Department, Faculty of medicine, King Abdulaziz university, Jeddah, Saudi Arabia
| | | | - Mohammad S Dairi
- Faculty of Medicine, Umm Al-Qura university, Mecca, Saudi Arabia
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Chen X. Pharmaceutical Sales Representatives in the United States and China: The Need for Professional Public Space. HEALTH CARE ANALYSIS 2021; 30:35-56. [PMID: 34761311 PMCID: PMC8580741 DOI: 10.1007/s10728-021-00438-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
Abstract
Pharmaceutical sales representatives (PSRs) are one of the most frequently used drug information sources for physicians in both the United States and China. During face-to-face interactions, PSRs use various promotional strategies to impact the prescribing behavior. In the United States, PSRs provide physicians small gifts, free drug samples, and “sincere friendships”, whereas in China, they played an indispensable role in medical corruption over the past three decades. To cope with the undue influence of PSRs, both these countries have taken positive but insufficient measures to eliminate the effect thus far. By comparing the strategies of American and Chinese PSRs, it was found that building a friendly personal relationship with physicians in a relatively closed private environment (such as physician’s office) is a key factor to exert an individualized influence on physicians, even in different social backgrounds and healthcare contexts. Therefore, this essay suggests that it is necessary to limit the establishment of personal relationships and maintain a more professional interaction to reduce the personalized psychological and emotional influences on physicians’ professional judgment. To achieve this goal, it is proposed to transfer the physician-PSR interaction to a professional public space as a supplement to current countermeasures and suggestions. The presence of others and the possibility of third party participation will stimulate more ethical and reputational concerns. It is hoped that the increased transparency of the interaction will promote participants to consider more professional norms and mitigate the undue influence of PSRs’ individualized strategies.
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Affiliation(s)
- Xiaoying Chen
- School of Humanities, Southeast University, 2 Southeast University Road, Jiangning District, Nanjing, 211189, People's Republic of China.
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GPs' perceptions of their relationship with the pharmaceutical industry: a qualitative study. BJGP Open 2021; 5:BJGPO.2021.0057. [PMID: 34353789 PMCID: PMC8596315 DOI: 10.3399/bjgpo.2021.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background The pharmaceutical industry invests heavily in promoting medications to physicians. This promotion may influence physicians’ prescribing behaviour and lead to inappropriately increased prescribing rates. Aim To understand GPs’ experience of interacting with the pharmaceutical industry, and explore their views and perceptions of the impact of this interaction in general practice in Ireland. Design & setting A qualitative design was used, and GPs practicing in Ireland were eligible. Method A combination of purposive and snowball sampling techniques was applied and semi-structured interviews were conducted. Thematic analysis was used to develop themes from the data. Results Twenty-one GPs and one GP trainee participated. Five themes were developed: 1) GP and pharmaceutical industry interface; 2) the industry’s methods of influence; 3) the uncomfortable relationship between GPs and industry; 4) GPs’ perceptions of being unconsciously influenced; and 5) GPs’ lack of knowledge of relevant regulations. Participants interacted with pharmaceutical representatives in their surgery and through continuing professional development (CPD). Reported methods of influence included biased information and the offer of gifts. Most participants felt their prescribing was unconsciously influenced. A minority felt that they were only influenced in a way that improved their prescribing. Conclusion The study shows that there can be a lack of clarity among GPs about relevant regulations and about the potential impact on prescribing of interactions with the pharmaceutical industry. Education of trainees and GPs has the potential to address this. Restrictions on interactions with the pharmaceutical industry may also play a role, although alternative CPD funding sources would need to be established.
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Influence of pharmaceutical promotion on prescribers in Jordan. Int J Clin Pharm 2020; 42:744-755. [PMID: 32140917 DOI: 10.1007/s11096-020-01006-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
Background Pharmaceutical promotion efforts should facilitate excellent quality patient care. However, there has been substantial debate about ethical principles related to pharmaceutical promotions. Objectives This study aimed to evaluate (i) attitudes toward pharmaceutical promotion among physicians in the private sector in Jordan, (ii) the impact of pharmaceutical promotion in influencing physicians' prescribing practices, and (iii) the prospect of academic detailing on this issue in Jordan. Setting The private health care sector in Jordan. Methods In this cross-sectional study, a self-administered questionnaire was distributed to a sample of physicians from the private health sector in Jordan during the period from December 2018 to March 2019. Descriptive statistics were conducted to describe physicians' attitudes toward pharmaceutical promotions, factors affecting prescribing practices, and perceptions toward academic detailing. Logistic regression models were performed to investigate predictors of acceptance and skepticism attitudes toward pharmaceutical promotion. Eisenberg model of physician decision-making was applied to evaluate factors influencing physicians' prescribing practice of promoted pharmaceutical products. Main outcome measure Attitudes toward pharmaceutical promotions, exposure to promoted pharmaceutical products, factors affecting physicians' prescribing practice of promoted pharmaceutical products, and their perceptions toward academic detailing and expected challenges. Results A total of 310 physicians completed the survey. The majority of physicians (73%) agreed that pharmaceutical companies provide valuable education on new pharmaceutical products. However, 66% of physicians agreed that lectures that are sponsored by pharmaceutical companies are often biased in favor of their products. Ninety-two percent of physicians agreed that drug samples were the most commonly offered promotional products by pharmaceutical companies. Being educated about the ethical principles related to pharmaceutical promotions among physicians was associated with higher likelihood of being skeptic about pharmaceutical promotional activities. Physicians' years of experience, payers' factors, environmental factors and participation in drug committees were significantly associated with high impact of marketing activities on physicians' prescribing practices (ORs of 1.2, 1.2, 1.49 and 0.43, respectively). The majority of participants in the current study reported positive attitudes toward applying academic detailing services in the future. Conclusions Education seems to play a crucial role in physicians' attitudes toward pharmaceutical promotion. Academic detailing is a promising strategy to counteract unethical marketing practice.
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Jacob NT. Drug promotion practices: A review. Br J Clin Pharmacol 2018; 84:1659-1667. [PMID: 29349812 PMCID: PMC6046507 DOI: 10.1111/bcp.13513] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/11/2017] [Accepted: 12/28/2017] [Indexed: 11/30/2022] Open
Abstract
Over the years, the pharmaceutical industry has been at the forefront of research and innovation in drug discovery and development. The process of drug discovery extending from preclinical studies to multicentric clinical trials and postmarketing phase is a costly affair running into billions of dollars. On the flip side, not all investigational molecules clear the trial phases and get approved, which puts pressure on the manufacturers to maximize the profit from approved drugs. It is in this key area that the practice of drug promotion plays its role. The World Health Organization defines drug promotion as "all informational and persuasive activities by manufacturers and distributors, the effect of which is to influence the prescription, supply, purchase or use of medicinal drugs". With its humble intent of creating awareness among healthcare professionals and updating their knowledge on recent advances in treatment options, drug promotion has been an important tool, but gradually it has evolved to embrace aggressive marketing strategies and sometimes unethical business and scientific practices where the need for profit-making eclipses commitment to patient care and scientific exploration. In this review, we discuss the evolution of drug promotion practices, the various types, its merits and demerits, the influence of drug promotion on physician prescribing behaviour, the role of regulatory bodies, unethical promotional practices and finally summarize with future directions.
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Affiliation(s)
- Nilan T. Jacob
- Department of PharmacologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)Puducherry605006India
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Fadare JO, Oshikoya KA, Ogunleye OO, Desalu OO, Ferrario A, Enwere OO, Adeoti A, Sunmonu TA, Massele A, Baker A, Godman B. Drug promotional activities in Nigeria: impact on the prescribing patterns and practices of medical practitioners and the implications. Hosp Pract (1995) 2018; 46:77-87. [PMID: 29426263 DOI: 10.1080/21548331.2018.1437319] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Pharmaceutical companies spend significant amount of resources on promotion influencing the prescribing behavior of physicians. Drug promotion can negatively impact on rational prescribing, which may adversely affect the quality of patient care. However, little is known about these activities in Nigeria as the most populous country in Africa. We therefore aimed to explore the nature of encounters between Nigerian physicians and pharmaceutical sales representatives (PSRs), and how these encounters influence prescribing habits. METHODS Cross-sectional questionnaire-based study conducted among practicing physicians working in tertiary hospitals in four regions of Nigeria. RESULTS 176 questionnaires were completed. 154 respondents (87.5%) had medicines promoted to them in the previous three months, with most encounters taking place in outpatients' clinics (60.2%), clinical meetings (46%) and new medicine launches (17.6%). Information about potential adverse effects and drug interactions was provided in 41.5%, and 27.3% of cases, respectively. Food, in the form of lunch or dinner, was the most common form of incentive (70.5%) given to physicians during promotional activities. 61% of physicians felt motivated to prescribe the drug promoted to them, with the quality of information provided being the driving factor. Most physicians (64.8%) would agree to some form of regulation of the relationship between medical doctors and the pharmaceutical industry. CONCLUSION Interaction between PSRs and physicians is a regular occurrence in Nigeria, influencing prescribing practices. Meals and cheap gifts were the most common items offered to physicians during their encounters with PSRs. The need for some form of regulation by professional organizations and the government was expressed by most respondents to address current concerns.
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Affiliation(s)
- Joseph O Fadare
- a Department of Pharmacology and Therapeutics , Ekiti State University , Ado-Ekiti , Nigeria
| | - Kazeem A Oshikoya
- b Department of Pharmacology , Therapeutics and Toxicology, Lagos State University College of Medicine , Lagos , Nigeria
| | - Olayinka O Ogunleye
- b Department of Pharmacology , Therapeutics and Toxicology, Lagos State University College of Medicine , Lagos , Nigeria
| | - Olufemi O Desalu
- c Department of Medicine , University of Ilorin , Ilorin , Nigeria
| | - Alessandra Ferrario
- d Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Okezie O Enwere
- e Department of Medicine , Imo State University , Orlu , Nigeria
| | - Adekunle Adeoti
- f Department of Medicine , Ekiti State University , Ado-Ekiti , Nigeria
| | | | - Amos Massele
- h Department of Clinical Pharmacology, Faculty of Medicine , University of Botswana , Gaborone , Botswana
| | - Amanj Baker
- i Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Brian Godman
- i Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- j Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden
- k Health Economics Centre , Liverpool University Management School , Liverpool , UK
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Mashalla Y, Setlhare V, Massele A, Sepako E, Tiroyakgosi C, Kgatlwane J, Chuma M, Godman B. Assessment of prescribing practices at the primary healthcare facilities in Botswana with an emphasis on antibiotics: Findings and implications. Int J Clin Pract 2017; 71. [PMID: 29178350 DOI: 10.1111/ijcp.13042] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/31/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIMS Inappropriate drug prescribing has increased especially in developing countries where systems for monitoring medicine use are not well developed. This increases the rate of antimicrobial resistance. The study aim was to assess the prescribing patterns among urban primary health facilities in Botswana to provide future guidance including developing future quality indicators. METHODS Retrospective data from patients' records between January and December 2013 in 19 clinics were collected in a cross-sectional study. The WHO/International Network for Rational Use of Drugs indicators were used to assess prescribing patterns in the study clinics. RESULTS Average number of drugs per prescription was 2.8; 78.6% of the prescribed antibiotics were by International Non-proprietary Name and 96.1% complied with the Botswana Essential Drugs List. Overall rate of antibiotic prescribing was high (42.7%) with 14.7%, 5.9% and 1.3% of prescriptions having two, three and four antibiotics, respectively. Systemic antibiotics (JO1C) accounted for 45.4% of prescribed antibiotics of which amoxicillin accounted for 28.4% and metronidazole 14.4% of all antibiotic prescriptions. There was low use of co-amoxiclav (0.3% of all antibiotic prescriptions). Third generation cephalosporins and macrolides accounted for 9.8% and 6.2% of antibiotic prescriptions respectively, with no prescribing of fluoroquinolones. The majority of indications (87%) for antibiotic prescriptions were according to ICD classification. CONCLUSIONS While most indications for antibiotic prescriptions were based on signs and symptoms according to ICD, antibiotic prescribing rates were high with some conditions not requiring antibiotics because they are viral infections. There is a need to further improve prescribing practices through induction and training of in-service prescribers. An effective management tool for monitoring antibiotic prescribing practices at Primary Health Care facilities should be designed and implemented, including developing robust quality indicators.
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Affiliation(s)
- Yohana Mashalla
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Vincent Setlhare
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Enoch Sepako
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Joyce Kgatlwane
- School of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Mpo Chuma
- School of Public Health, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Brian Godman
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
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Al-Areefi MA, Ibrahim MIM, Hassali MAA, Alfadl AA. Perceptions of Yemeni physicians about interactions with medical representatives. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mahmoud A. Al-Areefi
- Faculty of Public Health & Health Informatics; Umm Al Qura University; Makkah Saudi Arabia
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Matlala M, Gous AG, Godman B, Meyer JC. Structure and activities of pharmacy and therapeutics committees among public hospitals in South Africa; findings and implications. Expert Rev Clin Pharmacol 2017; 10:1273-1280. [PMID: 28776442 DOI: 10.1080/17512433.2017.1364625] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The WHO identified Pharmacy and Therapeutics Committees (PTCs) as a pivotal model to promote rational medicine use in hospitals. This matches a key South African (SA) government objective to establish PTCs in all hospitals to ensure rational, efficient and cost-effective use of medicines. However, documentation on the functionality of PTCs in public hospitals in SA is limited. Areas covered: This study aimed to address this. A 3-phased mixed methods approach involving questionnaires, observations of PTC meetings and semi-structured interviews was used. The findings were converged during the interpretation phase. Expert commentary: Most professionals were represented in the PTCs, with variations across hospitals. Membership of PTCs included a pharmacist, who in the majority of cases was the secretary. PTC activities included dissemination of decisions (100%) and formulary management (89.5%). However, reporting of adverse drug reactions (ADRs) and medication errors was typically poor at all hospital levels. Lack of expertise of pharmacoeconomic analysis and evidence-based decision-making in formulary management was identified as a key challenge in formulary management. In conclusion, future programmes should strengthen PTCs in specialised aspects of formulary management. Further training in the principles of pharmacovigilance is needed to enhance ADR reporting, as well as to ensure compliance with both WHO and provincial guidelines.
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Affiliation(s)
- Moliehi Matlala
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | - Andries Gs Gous
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
| | - Brian Godman
- b Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,c Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.,d Health Economics Centre , Liverpool University Management School, Liverpool University , UK
| | - Johanna C Meyer
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Pretoria , South Africa
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