Modeling the intention and usage of medicine vending machine: Using partial least squares-structural equation modelling and necessary condition analysis

Objective

This study aimed to investigate the factors influencing the intention to use and actual usage of medicine vending machines (MVMs) in China and to close the existing literature gap by examining the relationship between perceived convenience (PC), perceived trust, performance expectancy, effort expectancy, and social influence, on the intention to use MVM in a comprehensive manner. The impact of facilitating conditions on MVM adoption was also examined. Finally, customer age was tested as a moderator.

Methods

This was a cross-sectional study that used data collected through a self-administered questionnaire. A combination of partial least squares-structural equation modeling (PLS-SEM) and necessary condition analysis (NCA) technique was used to analyze and discuss the 308 valid questionnaires, test the hypotheses, and conduct an in-depth analysis.

Results

The results showed that PC, perceived trust, and performance expectancy were significantly related to the intention to use MVM. Effort expectancy was a non-significant predictor of intention to use MVM. Social influence was a significant negative predictor of the intention to use MVM. More importantly, performance expectancy was found to be a necessary factor for MVM intention, providing new marketing ideas for MVM owners. Age had a significant moderating effect on the facilitating conditions and intention to use vending machines. The relatively young population is more conscious of the facilitating conditions.

Conclusions

The findings of this study are of considerable importance as a guide for the main user group of vending machines. The combined analysis and discussion of PLS-SEM and NCA provide a sound theoretical basis for the practical implications of this study. In the future, we will attempt to use this technique in other areas of study. In terms of theoretical implications, this study provides technical references for future research.

Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study aims to analyze the trends in practice locations of family physicians in Taiwan between 1999 and 2018, using the databases of the Taiwan Association of Family Medicine and Taiwan Medical Association. Although the annual number of physicians registered as family physicians had steadily increased from 1876 in 1999 to 3655 in 2018, the ratio of family physicians practicing in hospitals to total family physicians remained stable around 40% in the study period. Even after eliminating the trainees who were entirely registered at hospitals, the proportion of hospital-based family physicians still accounted for about one-third of the total in each year. In conclusion, family physicians had been continuously demanded by hospitals in Taiwan. If the supply of primary care-oriented family physicians is insufficient outside hospitals, health manpower planning would require urgent adjustments.

Destigmatizing public health concerns and supply of COVID-19 vaccines

The end of the global pandemic caused by COVID-19 and a future without masks and restrictions are promising with the discovery of a vaccine. Still, there is much worry about the vaccine itself. Fears about what is inside the vaccine, how quickly it was created and plans for distribution are major concerns. This article aims to address these concerns to relieve vaccine hesitancy. Methods for distribution within the United States as well as different strategies to ensure proper and equitable allocation of COVID-19 vaccine worldwide is also described.

Distributing Publicly-Funded Influenza Vaccine-Community Pharmacies' Perspectives on Acquiring Vaccines from Public Health and from Private Distributors in Ontario, Canada

Objectives: To explore community pharmacies’ experience with two models of distribution for publicly-funded influenza vaccines in Ontario, Canada—one being publicly-managed (2015–2016 influenza season) and one involving private pharmaceutical distributors (2016–2017 season). Methods: Online surveys were distributed to community pharmacies across Ontario during the 2015–2016 and 2016–2017 influenza seasons with sampling proportional to Ontario Public Health Unit catchment populations. Quantitative data were analyzed descriptively and inferentially and qualitative data were summarized for additional context. Results: Order fulfillment appeared more responsive with the addition of private distributors in 2016–2017, as more pharmacies reported shorter order fulfillment times (p < 0.01); however, pharmacies reported significantly more days with zero on-hand inventory in 2016–2017 (p < 0.01), as well as more instances of patients being turned away due to vaccine unavailability (p < 0.05). In both seasons, a similar proportion of pharmacies reported slower order fulfillment and limited order quantities early in the season. Improved availability early in the season when patient demand is highest, more vaccines in a pre-filled syringe format, and better communication from distributors on product availability dates were recommended in qualitative responses. Conclusions: Introducing private distributors for the management and fulfillment of pharmacies’ orders for the publicly funded influenza vaccine appeared to have mixed results. While key concerns surrounding the frequency, responsiveness, and method of delivery were addressed by this change, challenges remain—in particular, acquiring sufficient vaccine early in the season to meet patient demand. As pharmacies become more prominent as vaccination sites, there are several opportunities to ensure that patient demand is met in this setting.

Developing statewide remdesivir use criteria

Purpose

This report describes our process of 4 health systems coming together to agree on standard use criteria for remdesivir as a coronavirus disease 2019 (COVID-19) treatment for patients in Utah. We hope our process provides a framework for remdesivir use in other states and insights on future use of other therapeutic agents that may also be in short supply, such as vaccines and monoclonal antibodies.

Summary

Emergency use authorization (EUA) criteria for COVID-19 treatments often allow for broad use of a treatment relative to limited supplies. Without national criteria, each health system must develop further rationing criteria. Health systems in Utah worked together as part of the state’s crisis standards of care workgroup to develop a framework for how to limit the EUA criteria for remdesivir to match available supplies. The 4 largest health systems were represented by infectious diseases specialists, chief medical officers, and pharmacists. The group met several times online and communicated via email over a 9-day period to develop the criteria. The clinicians agreed to use this framework to develop criteria for future therapeutics such as monoclonal antibodies.

Conclusion

The unique collaboration of the 4 health systems in Utah led to statewide criteria for use of remdesivir for patients with COVID-19, ensuring similar access to this limited resource for all patients in Utah.

CTSA pharmacies: Contribution to research and public health during the COVID-19 pandemic

INTRODUCTION

In March 2020, academic medical center (AMC) pharmacies were compelled to implement practice changes in response to the COVID-19 pandemic. These changes were described by survey data collected by the Clinical and Translational Science Awards (CTSA) program which were interpreted by a multi-institutional team of AMC pharmacists and physician investigators.

METHODS

The CTSA program surveyed 60 AMC pharmacy departments. The survey included event timing, impact on pharmacy services, and corrective actions taken.

RESULTS

Almost all departments (98.4%) reported at least one disruption. Shortages of personal protective equipment (PPE) were common (91.5%) as were drug shortages (66.0%). To manage drug shortages, drug prioritization protocols were utilized, new drug supply vendors were identified (79.3%), and onsite compounding was initiated. PPE shortages were managed by incorporating the risk mitigation strategies recommended by FDA and others. Research pharmacists supported new clinical research initiatives at most institutions (84.0%), introduced use of virtual site visits, and shipped investigational drugs directly to patients. Some pharmacies formulated novel investigational products for clinical trial use. Those AMC pharmacies within networked health systems assisted partner rural and inner-city hospitals by sourcing commercial and investigational drugs to alleviate local disease outbreaks and shortages in underserved populations. Pharmacy-based vaccination practice was expanded to include a wider range of pediatric and adult vaccines.

CONCLUSION

The COVID-19 pandemic radically altered hospital pharmacy practice. By adopting innovative methods and adapting to regulatory imperatives, pharmacies at CTSA sites played an extremely important role supporting continuity of care and collaborating on critical clinical research initiatives.

To Work at Clinics or at Hospitals? Analysis of Family Physician Recruitment Advertising in Taiwan

Family physicians act as gatekeepers of the healthcare system and have an indispensable role in providing holistic care in the primary care system. While previous studies had focused on the geographic maldistribution of family physicians, the current study investigated the distribution of job opportunities for family physicians by analyzing recruitment advertisements posted in medical association journals, as an indirect way to observe the marketplace demand for physicians. We collected all the recruitment advertisements for family physicians in the twelve issues of the Taiwan Medical Journal, the official organ of the Taiwan Medical Association, in 2018. In contrast to 124 new trainees annually, 739 advertisements for family physicians were posted within the entire year. After eliminating repeated advertisements, there were 302 distinct advertisements, of which hospitals accounted for 18.9% (n = 57). The job opportunities at hospitals were offered mainly by regional hospitals (n = 26) and community hospitals (n = 29), but only two by medical centers. Family physicians in Taiwan were in great demand not only by primary care clinics but also by hospitals. The role of family physicians in hospitals is worth further study.

Prioritized Criteria for Casualty Distribution following Trauma-related Mass Incidents; a Modified Delphi Study

INTRODUCTION

In the aftermath of mass casualty incidents (MCIs), many decisions need to be made in a fast and influential manner in a high pressure environment to distribute the limited resources among the numerous demands. This study was planned to rank the criteria influencing distribution of casualties following trauma-related MCI.

METHODS

This study utilized a modified Delphi methodology, concentrating on extracted criteria attained from preceding systematic literature reviews. The 114 extracted criteria were classified into eight sections including space, staff, equipment, system and structures, triage, treatment, transport, and uncategorized criteria and were imported into an online survey tool. In the first round, experts were asked to rank each criterion on a five-point Likert scale. The second round incorporated feedbacks from the first round, stating percent and median scores from the panel as a whole. Experts were then called upon to reassess their initial opinions regarding uncertain remarks from the first round, and once again prioritize the presented criteria.

RESULTS

Fifty-seven criteria were regarded as relevant to the following sections: space: 70% (7/10); staff: 44% (4/9); system / structure: 80% (4/5); equipment: 39.1% (9/23); treatment; 66.7% (6/9); triage: 73.7% (14/19); transport: 38.7% (12/31) and other sections: 12.5% (1/8). The first round achieved nearly 98% (n=48) response rate. Of the 114 criteria given to the experts, 68 (almost 60%) were approved. The highest percentage of approval belonged to the system and structures sections (4/5=80%). The response rate for the second round was about 86% (n=42). A consensus could be reached about nearly 84% (57) of the 68 criteria presented to experts.

CONCLUSION

"Casualty Level of Triage on the Scene" and "Number of Available Ambulances" were the two criteria that obtained the highest level of consensus. On the other hand, "gender of casualty", "Number of Non-Medical staff in each Hospital" and "Desire to transport family members together" got lowest level of consensus. This sorted list could be used as a catalogue for developing a decision support system or tool for distribution of victims following mass casualty incidents.

What about the health workforce distribution in rural China? An assessment based on eight-year data

INTRODUCTION

Health, as a fundamental human right, and its fairness and equality have gradually been reiterated and emphasized around the world. The inequality in health workforce distribution is common in China and many other developing countries. However, it is unknown whether the economic conditions and insufficient supply of village physicians in rural areas worsens health inequality. This study and article aimed to explore and discuss the inequality in health workforce in rural China.

METHODS

Inequality in health workforce distribution of rural China as well as trends of village physician-to-population ratios from 2009 to 2016 were measured by the Lorenz curve/Gini coefficient and Theil L index, and compared between four divisions: eastern, central, western and north-eastern.

RESULTS

The Gini coefficient of village physicians compared with population from 2009 (0.062) to 2016 (0.038) showed absolute equality in rural China. In contrast, the Thiel L index from 2009 (0.380) to 2016 (0.347) showed less equality. The decomposition of Thiel L index implicated the inequalities within the divisions, which contributed about 85% to the total Theil L index. The eastern division's Theil L index was the highest of the divisions.

CONCLUSIONS

Chinese village physician distribution is generally equitable. But there are obvious inequalities existing with the divisions. To achieve a more equitable distribution of health workforce in rural China, the cultivation and retention of village physicians needs to keep pace with the increase in health service demand among rural residents. In addition, government should pay more attention to the inequality in village physician distribution between different regions, as well as within a region.

Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective

Background: The maldistribution of licensed doctors is one of the major challenges faced by the Chinese health sector. However, this subject remains underexplored, as the underlying causes of licensed doctor distribution have not been fully mapped out. To fill the research void, this study theoretically modeled and empirically measured various determinants of licensed doctor distribution from both the supply and demand sides while taking the spillover effect between the adjacent geographical units into consideration. Methods: The theory of demand and supply is adopted to construct a research framework so as to explain the imbalance in the licensed doctor distribution. Both direct effects and spillover effects of the supply-side factors and demand-side factors are empirically measured with the spatial panel econometric models. Results: The health service demand was found, as expected, to be the major driving force of the licensed doctor distribution across the nation. That is, the increase in health services demands in a province could significantly help one unit attract licensed doctors from adjacent units. Unexpectedly but intriguingly, the medical education capacity showed a relatively limited effect on increasing the licensed doctor density in local units compared with its spillover effect on neighboring units. In addition, government and social health expenditures played different roles in the health labor market, the former being more effective in increasing the stock of clinicians and public health doctors, the latter doing better in attracting dentists and general practitioners. Conclusions: The results provide directions for Chinese policy makers to formulate more effective policies, including a series of measures to boost the licensed doctor stock in disadvantaged areas, such as the increase of government or social health expenditures, more quotas for medical universities, and the prevention of a brain drain of licensed doctors.

Blockchain Technology for Detecting Falsified and Substandard Drugs in Distribution: Pharmaceutical Supply Chain Intervention

Background

Drug counterfeiting is a global problem with significant risks to consumers and the general public. In the Philippines, 30% of inspected drug stores in 2003 were found with substandard/spurious/falsely-labeled/falsified/counterfeit drugs. The economic burden on the population drug expenditures and on governments is high. The Philippine Food and Drug Administration (FDA) encourages the public to check the certificates of product registration and report any instances of counterfeiting. The National Police of Philippines responds to such reports through a special task force. However, no literature on its impact on the distribution of such drugs were found. Blockchain technology is a cryptographic ledger that is allegedly immutable through repeated sequential hashing and fault-tolerant through a consensus algorithm. This project will develop and test a pharmacosurveillance blockchain system that will support information sharing along the official drug distribution network.

Objective

This study aims to develop a pharmacosurveillance blockchain system and test its functions in a simulated network.

Methods

We are developing a Distributed Application (DApp) that will run on smart contracts, employing Swarm as the Distributed File System (DFS). Two instances will be developed: one for Ethereum and another for Hyperledger Fabric. The proof-of-work (PoW) consensus algorithm of Ethereum will be modified into a delegated proof-of-stake (DPoS) or practical Byzantine fault tolerance (PBFT) consensus algorithm as it is scalable and fits the drug supply chain environment. The system will adopt the GS1 pedigree standard and will satisfy the data points in the data standardization guidelines from the US FDA. Simulations will use the following 5 nodes: for FDA, manufacturer, wholesaler, retailer, and the consumer portal.

Results

Development is underway. The design of the system will place FDA in a supervisory data verification role, with each pedigree type–specific data source serving a primary data verification role. The supply chain process will be initiated by the manufacturer, with recursive verification for every transaction. It will allow consumers to scan a code printed on the receipt of their purchases to review the drug distribution history.

Conclusions

Development and testing will be conducted in a simulated network, and thus, results may differ from actual practice. The project being proposed is disruptive; once tested, the team intends to engage the Philippine FDA to discuss implementation plans and formulate policies to facilitate adoption and sustainability.

Registered Report Identifier

RR1-10.2196/10163

U.S. vaccine and immune globulin product shortages, 2001-15

PURPOSE

Trends in shortages of vaccines and immune globulin products from 2001 through 2015 in the United States are described.

METHODS

Drug shortage data from January 2001 through December 2015 were obtained from the University of Utah Drug Information Service. Shortage data for vaccines and immune globulins were analyzed, focusing on the type of product, reason for shortage, shortage duration, shortages requiring vaccine deferral, and whether the drug was a single-source product. Inclusion of the product into the pediatric vaccination schedule was also noted.

RESULTS

Of the 2,080 reported drug shortages, 59 (2.8%) were for vaccines and immune globulin products. Of those, 2 shortages (3%) remained active at the end of the study period. The median shortage duration was 16.8 months. The most common products on shortage were viral vaccines (58%), especially hepatitis A, hepatitis B, rabies, and varicella vaccines (4 shortages each). A vaccine deferral was required for 21 shortages (36%), and single-source products were on shortage 30 times (51%). The most common reason for shortage was manufacturing problems (51%), followed by supply-and-demand issues (7%). Thirty shortages (51%) were for products on the pediatric schedule, with a median duration of 21.7 months.

CONCLUSION

Drug shortages of vaccines and immune globulin products accounted for only 2.8% of reported drug shortages within a 15-year period, but about half of these shortages involved products on the pediatric vaccination schedule, which may have significant public health implications.

General practice departments of university hospitals and certified training programs for general practitioners in Japan: A nationwide questionnaire survey

Background

In the reform of specialist training by Japanese Medical Specialty Board, general practice is expected to be one of 19 core specialties. University departments of general practice can play a central role in training board‐certified generalists, but whether they are actually preparing to do so is unknown.

Method

We sent a questionnaire to 79 universities and requested to forward it to the general practice department. Fifty‐six departments of general practice (37 public and 19 private universities) completed the questionnaire (response rate 71%).

Results

Fifty‐one (91.9%) universities planned to be the base institutes of certified programs. The annual seats per program ranged from 2 to 20 (median 5). In these 51 university‐based programs, 33 (64.7%) departments provide the general practice II element. Twenty‐eight (54.9%) require the program trainees to belong to the departments (do nyukyoku) and 11 (21.6%) recommend that they do so. Forty‐seven (92.2%) programs had affiliated institutions in rural areas. Thirty‐nine (76.5%) were willing to accept graduates of regional quota (chiikiwaku). Twenty‐nine (56.9%) program directors took into account the obligatory service of regional quota when making the programs. Programs that accept regional quota graduates were more likely to be affiliated with rural institutions (P=.002) and conscious of the obligatory service in making the program than other programs (P<.001).

Conclusion

Most of the university departments have their own training programs. Many of them are willing to accept nyukyoku doctors and regional quota graduates. Universities intend to play an important role in graduating generalists and supporting their careers.

[Repeated BCG vaccine stockouts in France: local findings and consequences in a primary health care centre in Seine-Saint-Denis]

France is the European country most severely impacted by BCG vaccine stockouts that started in 2013. After a brief history of French tuberculosis vaccine regulations, this article describes the dysfunctions induced by these shortages in a primary health care centre in Seine-Saint-Denis, the department with the highest incidence of tuberculosis in France.Field observations reveal two types of shortcomings in the institutional communication to healthcare professionals: incomplete communication on projected shortages and their duration; lack of technical information on BCG multidose vials for the Polish market replacing BCG SSI. We then report the consequences of this poor information on the performances of the primary health care centre and its workers.In the light of this situation, we propose ways to improve policy implementation, especially by creating bottom-up communication channels from healthcare professionals towards health agencies.

Projected future distribution of dentists in Japan

OBJECTIVES

Appropriate health policies for the supply of dentists have been an ongoing issue in many developed countries. The purpose of this study was to estimate the future distribution of dentists with different working statuses in Japan and to discuss policy implications about the supply of dentists in any country.

METHODS

This was a retrospective cohort study using data from the National Survey of Physicians, Dentists and Pharmacists for 1972-2012. Based on data from the 2010 and 2012 surveys, we calculated by means of a Markov model the future number of dentists with different working statuses until 2042 according to sex.

RESULTS

We estimated that the total number of active dentists will decrease from 2012 to 2042. The number of active dentists per 1,000 population was predicted to reach a peak in 2018, decrease by 4.2% from 2012 to 2038, and thereafter slightly increase. With regard to working status, the number of dentists with their own practices per 1,000 people was predicted to have reached a peak in 2014 and decrease by 22.0% until 2042. We estimated that the number of dentists used in dental clinics per 1,000 population will increase continuously between 2012 and 2042 by 20.0%.

CONCLUSIONS

Our study suggests that maintaining this supply of dentists may lead to maldistribution of their working status in the future.

Reviewing the importance of the cold chain in the distribution of vaccines

Vaccination is an effective public health measure to prevent and control a number of infectious diseases. However, since vaccines are biological products and are sensitive to both heat and cold, they need to be maintained within a narrow range of temperatures, often referred to as the 'cold-chain'. This range, which is between +2°C and +8°C with a target +5°C, does not allow for refreezing or storage at room temperature. This paper discusses the importance of the cold chain, what should be done both to maintain it, and the actions to be taken, should a break be noted. It is important to note the product information supplied with vaccines, which is taken from the summary of product characteristics that forms part of the licensing requirements for each vaccine, and which will state how it should be stored. Using a vaccine that has not been stored according to these instructions constitutes off-label use, for which the individual practitioner must take responsibility. It also emphasises the fragile nature of many public health interventions, maintenance of which require constant vigilance and close cooperation between many groups and individuals.

Attitudes toward working in rural areas of Thai medical, dental and pharmacy new graduates in 2012: a cross-sectional survey

BACKGROUND

Inequity in health workforce distribution has been a national concern of the Thai health service for decades. The government has launched various policies to increase the distribution of health workforces to rural areas. However, little is known regarding the attitudes of health workers and the factors influencing their decision to work in rural areas. This study aimed to explore the current attitudes of new medical, dental and pharmacy graduates as well as determine the linkage between their characteristics and the preference for working in rural areas.

METHODS

A cross-sectional survey was conducted, using self-administered questionnaires, with a total of 1,225 medical, dental and pharmacy graduates. They were participants of the meeting arranged by the Ministry of Public Health (MOPH) on 1-2 April 2012. Descriptive statistics using mean and percentage, and inferential statistics using logistic regression with marginal effects, were applied for data analysis.

RESULTS

There were 754 doctors (44.4%), 203 dentists (42.6%) and 268 pharmacists (83.8%) enrolled in the survey. Graduates from all professions had positive views towards working in rural areas. Approximately 22% of doctors, 31% of dentists and 52% of pharmacists selected 'close proximity to hometown' as the most important reason for workplace selection. The multivariable analysis showed a variation in attributes associated with the tendency to work in rural areas across professions. In case of doctors, special track graduates had a 10% higher tendency to prefer rural work than those recruited through the national entrance examination.

CONCLUSIONS

The majority of graduates chose to work in community hospitals, and attitudes towards rural work were quite positive. In-depth analysis found that factors influencing their choice varied between professions. Special track recruitment positively influenced the selection of rural workplaces among new doctors attending the MOPH annual meeting for workplace selection. This policy innovation should be applied to dentists and pharmacists as well. However, implementing a single policy without supporting strategies, or failing to consider different characteristics between professions, might not be effective. Future study of attitudes and factors contributing to the selection of, and retention in, rural service of both new graduates and in-service professionals was recommended.

Thailand special recruitment track of medical students: a series of annual cross-sectional surveys on the new graduates between 2010 and 2012

BACKGROUND

Comprehensive policies for rural retention of medical doctor and other health professional, including education strategy and mandatory service, have been implemented in Thailand since the 1970s. This study compared the rural attitudes, intention to fulfil mandatory rural service and competencies between medical graduates' from two modes of admission, normal and special tracks.

METHODS

Three cross-sectional, self-administered questionnaire surveys were conducted in April 2010, 2011 and 2012. The questionnaire was distributed to all new medical graduates in the annual Ministry of Public Health meeting to allocate workplaces for the 3-year mandatory service.

FINDINGS

The majority of students were recruited through the normal track (56 to 77%) from medical schools in Bangkok (56 to 66%), having mostly attended secondary schools in Bangkok. A majority of special track graduates came from secondary schools in provincial cities (76 to 79%). All three batches came from well-educated parents.A slight difference in rural attitudes was observed between tracks. Univariable analysis found statistical associations between the intention to fulfil the 3-year obligation and special track recruitment and attributes on rural exposure. Multivariable analysis showed that graduates recruited through the special track had a 10 to 15% higher probability of fulfilling the mandatory service.Special track graduates scored higher on four out of five competencies, notably procedural skills, but normal track graduates had higher competency on clinical knowledge in major clinical subjects.

CONCLUSION

Since special track recruitment resulted in a higher probability of fulfilling mandatory service and competency, increasing the proportion of special track recruitment and improving the effectiveness of policies addressing physician shortage were recommended.

Causes of discontinuity of blood donation among donors in Shiraz, Iran: cross-sectional study

CONTEXT AND OBJECTIVE

the adequacy of blood depends on blood donation rates and numbers of blood donors. To prepare adequate blood supplies, it is essential to investigate the barriers and factors that stop individuals from donating. This study aimed to identify the causes of lapsed donation at our center.

DESIGN AND SETTING

cross-sectional study of volunteer blood donors in Shiraz, Iran.

METHODS

we selected 850 donors who had donated between January 1, 2005 and June 1, 2005, but had not donated again by June 2008. The participants were recruited by letter and telephone, and were interviewed using a specially designed questionnaire that contained items on demographic characteristics, donor motivations and reasons for not returning to donate. We used the chi-square test to identify associations between lapsed donor characteristics and reasons for declining to donate.

RESULTS

the greatest motivation for donation was altruism. The most frequent reasons for lapsed donation were lack of time because of work and self-exclusion for medical reasons. Among first-time donors, the most frequent reasons were unsuitability for donation and lack of time.

CONCLUSIONS

the reasons for not returning to donate are varied and may correlate with demographic characteristics. In this study, the main reason for not returning was lack of time. Changing donation hours so that donors can donate after work, providing mobile teams at workplaces, and shortening the duration of the donation process may help increase repeat donation rates.

Value and types of medicines returned by patients to sultan qaboos university hospital pharmacy, oman

OBJECTIVES

Frequent physician visits, improper therapeutic adherence and treatment modification after hospitalisation could result in unused medicine accumulating at home. This study aims to examine the value and types of medicines returned by patients at a tertiary care unit in Oman.

METHOD

All medicines voluntarily returned to Sultan Qaboos University Hospital main pharmacy between February and June 2003 were reviewed. The cost of these medicines and potential cost saving, if some were returned to the hospital distribution cycle, were computed. A method of determining by physical observation whether they can be recycled was developed based on institutional-based guidelines and criteria.

RESULTS

Three hundred and eighty one patients returned their medicines (69% female). The patients returned a total of 1071 drugs (mean per patient 3.1 per month) corresponding to a total cost of Omani Rials (OR) 20,140 (mean per patient OR 10.6) (1 OR = 2.58 US dollar). Potential cost saving was OR 5,550 (mean per patient OR 2.9). Medicines of the cardiovascular group were returned in greatest number (24%) while anti-infective drugs had the highest share of the total cost (61%).

CONCLUSION

The study identified values and types of medicines returned by patients at tertiary care unit in Oman. Medications used for cardiovascular and infectious diseases appeared as the most frequent and the most expensive returned medicines. It suggests that health care providers in Oman should devise health education programmes to improve proper utilization of medicine.