[Attitudes and opinions of general practitioners and lung specialists about a new medicines counselling service for asthma patients in community pharmacies: a qualitative study]

INTRODUCTION

Since October 2013, pharmacists can offer a new medicines counselling service (NMC). to asthma patients, who start a treatment with an inhaled corticosteroid. Although this individualized service can be organized at the request of the general practitioner (GP). the patient or the pharmacist, the uptake remains quite low. The limited involvement of GPs has already been identified as one of the obstacles to the successful implementation of this project.

OBJECTIVE

To explore the attitudes and opinions of GPs and pulmonologists about NMC.

METHOD

Focus group discussions with GPs were organized during eight meetings of local quality groups in the province of Antwerp, at which a total of 72 physicians were present. Also, five pulmonologists and two GPs with expertise in organization of primary healthcare participated in an interview.

RESULTS

A large group of GPs was not aware of the existence of NMC and only a small number of them had experience with it. Nearly all pulmonologists and GPs agreed that repetition of the inhalation technique and follow-up of the adherence are useful. However, there was disagreement about the importance of taking the Asthma Control Test and explaining the pathology by the pharmacist. We could find five barriers that made physicians withhold support for the NMC. The most important obstacle seemed to be that the pharmacist is not obligated to communicate with the physician about the service. In addition, mainly GPs believed that the remuneration is too high and too focused on the number of NMC services performed and that pharmacists enter their domain with delivering this service. Both pulmonologists and GPs were concerned about how the pharmacist will include patients in a NMC, because it isn't always clear what the indication is of the prescribed inhaled corticosteroid. Furthermore, everyone was convinced that the inclusion criteria should be extended, since each patient using inhalation therapy, would benefit from additional support. Finally, some physicians had an objection to the fact that pharmacists are not obliged to follow an additional course before providing the service.

CONCLUSION

The opinions of GPs about NMC were mixed and rather critical, while pulmonologists were somewhat more enthusiastic about the initiative. Although all physicians agreed that there is room for improvement of the concept, some GPs are willing to prescribe BNM for certain patients.

[Opinions and attitudes of Flemish pharmacists and general practitioners towards INN prescribing. A survery in Antwerp and East Flanders]

INTRODUCTION

Since 2002 in Belgium, physicians are allowed to prescribe by International Non-proprietary Name (INN). In 2005, the conditions for this decree were set. Examples from other countries have shown that INN prescribing can significantly contribute to controlling pharmaceutical expenditures. The share of INN prescriptions remains low in Belgium (7% in 2011).

OBJECTIVE

To formulate an answer to the question: what are the opinions and attitudes of pharmacists and general practitioners [GP's] with regards to INN prescribing?

METHOD

In the winter of 2011-2012, a questionnaire with closed-ended questions was send to pharmacists and GP's in the provinces of Antwerp and East-Flanders, through training days and personal visits. Pharmacists and GP's scored a list of statements with a 5-point Likert scale. The themes of the statements related to: delivering INN prescriptions, legislation, impact on expenditures, choices regarding patient concerns and interprofessional relations.

RESULTS

In total, 353 questionnaires were completed and returned of which 228 165%1 were by pharmacists and 125 (35%1 by GP's. Although both declared to be sufficiently up to date with regulations to prescribe (84%) or to deliver (95%] a INN prescription, only 13% of the pharmacists said all prescription they receive contain the correct information. Less GP's [36%) than pharmacists (82%] feel aided by their software program when prescribing or delivering an INN prescription. GP's rely mostly on NIHDI (National Institute for Health and Disability Insurance) as the main source for information on INN prescribing, pharmacists rely on the [Local) pharmacists association. The pharmacists and GP's in the study who relied on NIHDI as main information source, were less aware of legislation concerning INN [N2, p<0,05] than those who rely on the local professional association [N2, p<0,0001]. All pharmacists in the study said to consider the patients medication history when delivering an INN prescription for chronic treatment. However, 57% of the GP's preferred not to prescribe by INN for the reason that they are not sure whether the pharmacist will always consider the patients medication history in case of an INN prescription. Although the GP's showed certain motivation to prescribe by INN, it was no greater than for generic prescribing. And INN prescribing has no added value compared to generic prescribing, according to the GP's. For the pharmacists, INN prescribing does contain an opportunity. With the increase in numbers of dosages and sorts of packaging of generic products, it becomes more and more difficult for pharmacists to manage their stock. In case of an INN prescription, the pharmacist can choose between the different packages in his stock. This offers opportunities especially for acute conditions.

CONCLUSION

INN prescribing is a good example of where the collaboration between pharmacists and GP's still contains a lot of opportunities, as well for the two professions, as the government and the patient in terms of controlling the pharmaceutical expenditures. Also the education for pharmacist or GP can further contribute to the sensitization of INN prescribing. In practice, there remain a number of issues and differences in opinions between pharmacists and general practitioners regarding INN prescribing. GP's feel few motivation to prescribe by INN and the government has put no imperative demands towards prescribers. Further evaluation of the practicaL feasibility of the current conditions for prescribing and delivering INN prescriptions is needed.

Potential impact of policy regulation and generic competition on sales of cholesterol lowering medication, antidepressants and acid blocking agents in Belgium

BACKGROUND

Pharmaceutical expenditures are increasing as a proportion of health expenditures in most rich countries. Antidepressants, acid blocking agents and cholesterol lowering medication are major contributors to medicine sales around the globe.

METHODS

We aimed to document the possible impact of policy regulations and generic market penetration on the evolution of sales volume and average cost per unit (Defined Daily Doses and packages) of antidepressants, acid blocking agents and cholesterol lowering medication. We extracted data from the IMS health database regarding the public price and sales volume of the antidepressants (selective serotonin reuptake inhibitors (SSRI's), monoamine oxidase inhibitors (MAOl's) and tricyclic and remaining antidepressants (TCA's)), acid blocking agents (proton pump inhibitors (PPl's) and H2 receptor antagonists) and cholesterol lowering medication (statins and fibrates) in Belgium between 1995 and 2009. We describe these sales data in relation to various national policy measures which were systematically searched in official records.

RESULTS

Our analysis suggests that particular policy regulations have had immediate impact on sales figures and expenditures on pharmaceuticals in Belgium: changes in reimbursement conditions, a public tender and entry of generic competitors in a reference pricing system. However, possible sustainable effects seem to be counteracted by other mechanisms such as marketing strategies, prescribing behaviour, brand loyalty and the entry of pseudogenerics. It is likely that demand-side measures have a more sustainable impact on expenditure.

CONCLUSION

Compared with other European countries, generic penetration in Belgium remains low. Alternative policy regulations aimed at enlarging the generic market and influencing pharmaceutical expenditures deserve consideration. This should include policies aiming to influence physicians' prescribing and a shared responsibility of pharmacists, physicians and patients towards expenditures.

Differences in the perception of a mass media information campaign on drug and alcohol consumption

The two-month mass media campaign in Belgium on drug and alcohol consumption "Alcohol and other drugs. The facts and fictions" initiated in January 2008 has been evaluated shortly after by a phone survey. This article reports some indicators on the public awareness of the campaign, and the differences in the perception according to age groups and education levels.

About 1,000 respondents (n = 1,002) accepted to participate in the campaign evaluation. Response rate is 37.1%. Global perception of the campaign - measured by the capacity to identify the campaign adequately - is 18.8%. This perception varies between age groups and education levels: 30% of the youngest age group (14-35 yrs) have seen the campaign, 13% of people aged 56 and over (p<0.001). The lower the education level, the lower the probability to have seen the campaign (11% in the lowest group, 25% in the highest one, p<0.001).

Among the respondents who have seen the campaign, newspapers are the most often cited media for the oldest age groups. Inversely, young people have mainly identified the campaign on street boards or on post cards.

The privileged type of media is also function of the education level. People belonging to the lowest educational level report more often to have seen the campaign on TV (85% vs 51% in the highest group, p<0.01), while the reverse is true for seeing the campaign via the newspapers or the street boards.

The results indicate that there are socio-economic variations in the perception of the campaign. In health promotion, reaching lower socio-economic groups still remains a real challenge. Channels for such campaigns have to be carefully chosen to reach their target groups and ask to be complemented with community based interventions.