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Ronse M, Nguyen TT, Nguyen XX, Ingelbeen B, Schneiders ML, Tran DT, Muela Ribera J, Gryseels C, Peeters Grietens K. Use of antimicrobials and other medical products in an ethnic minority context of South-Central Vietnam: A qualitative study of vulnerability. PLOS Glob Public Health 2024; 4:e0002982. [PMID: 38593159 PMCID: PMC11003614 DOI: 10.1371/journal.pgph.0002982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 02/09/2024] [Indexed: 04/11/2024]
Abstract
Despite the global threat of antimicrobial resistance (AMR), evidence on the use and quality of medicines at community level is limited, particularly in impoverished, rural areas where prevalence of (bacterial) infections is high. To better understand the processes that drive vulnerability to AMR' effects, this study aimed to assess social factors underpinning access to-and use of-medical products and healthcare, among people from the Raglai ethnic minority in Ninh Thuan Province, Vietnam. We conducted ethnographic research in eight villages in 2018-2019, using interviewing and participant observation methods for data collection. Different types of informants (including community members and healthcare providers) were selected using purposive sampling strategies and analysis was retroductive. Our findings show that, despite the existence of a government-funded health insurance scheme, Raglai people's flexible therapeutic itineraries did not systematically start with formal healthcare. Different types of care (private/informal, public, shamanic) were combined in parallel or in alternation, determined by distance to the provider, cost, workload, perceived diagnostic capacity, perceived severity and aetiology of the illness, and trust in the provider. Available medicines were often tablets dispensed in plastic bags containing labelled tablets, unlabelled tablets (in bulk) or tablets ground to powder. Treatment was often considered effective when it relieved symptoms, which led to abandonment of the treatment course. When symptoms did not speedily abate, the illness aetiology would be reinterpreted, and "stronger" medicines would be sought. The precarious socio-economic status of some Raglai drove them in cycles of severe poverty when additional unforeseen factors such as illness, animal disease or loss of crops arose, hampering access to (in)formal healthcare providers and/or appropriate diagnosis and treatment. We conclude that Raglai communities are structurally unable to buffer themselves against the threat and consequences of AMR. Despite this vulnerability, they are among the least targeted by efforts to optimize antibiotic use, which are concentrated in secondary and tertiary healthcare facilities targeted at urban populations.
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Affiliation(s)
- Maya Ronse
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thuan Thi Nguyen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Malaria Epidemiology, National Institute of Malariology, Parasitology, and Entomology, Hanoi, Vietnam
| | - Xa Xuan Nguyen
- Department of Malaria Epidemiology, National Institute of Malariology, Parasitology, and Entomology, Hanoi, Vietnam
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Duong Thanh Tran
- Department of Malaria Epidemiology, National Institute of Malariology, Parasitology, and Entomology, Hanoi, Vietnam
| | - Joan Muela Ribera
- Department of Anthropology, Philosophy and Social Work, Rovira i Virgili, Tarragona, Spain
| | - Charlotte Gryseels
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Manirakiza A, Gitonga Nyamu D, Maru SM, Bizimana T, Nimpagaritse M. Evaluating drug use patterns among paediatric outpatients in Burundi. J Pharm Policy Pract 2024; 17:2312369. [PMID: 38444527 PMCID: PMC10914302 DOI: 10.1080/20523211.2024.2312369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background Rational prescribing is key to optimising therapeutic outcomes and avoiding risks associated with irrational use of medicines. Using WHO drug use indicators, this study evaluated drug use patterns among paediatric outpatient encounters at Primary Healthcare Centers (PHCs) in Bujumbura Mairie, Republic of Burundi. Methods Descriptive cross-sectional research assessed paediatric medicine use in 20 PHCs. From 8 February to 7 April 2023, 800 randomly selected paediatric encounters' 2022-year data were retrospectively collected. Data for specific facility indicators were prospectively collected. SPSS 23 was used to analyse data. Results 800 outpatient child encounters were analysed, 48.4% female and 51.6% male. The mean number of medicines per encounter was 2.4(±0.99). The injection rate was 9.9%. Overall, 78.8% of generics and 85.2% of essential medicines were prescribed. Results show drug prescribing differences between private and government PHCs (p < 0.001). All PHCs studied had no standard treatment guidelines (STGs), while 50% had an essential medicine list (EML) and 85% of key medicines were available. Conclusion Poor prescribing practices were found indicating the need for interventions to promote good drug use practices. A large study at a national scale is required to provide a more comprehensive understanding of the overall drug use practices.
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Affiliation(s)
- Audace Manirakiza
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David Gitonga Nyamu
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, Faculty of Health Sciences, University of Naïrobi, Nairobi, Kenya
| | - Shital Mahindra Maru
- Faculty of Health Sciences, Department of Pharmaceutical Chemistry, Pharmaceutics and Pharmacognosy, University of Naïrobi, Nairobi, Kenya
| | - Thomas Bizimana
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Adeosun SA, Joda AE, Aderemi-Williams RI, Oyetunde OO. Assessment of drug use in primary health centers in Lagos State, Nigeria. Pan Afr Med J 2022; 43:58. [PMID: 36578811 PMCID: PMC9755715 DOI: 10.11604/pamj.2022.43.58.36231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction rational drug use prevents wastage of resources, loss of confidence in healthcare system and drug-related morbidity and mortality. This study aims to assess drug use in Primary Health Centers (PHCs) in Lagos State, Nigeria using the World Health Organization in collaboration with the International Network of Rational Use of Drugs core drug use indicators. Methods the study was conducted between February to October 2021 as a comparative observational survey of selected PHCs. It included a retrospective and prospective cross-sectional design for prescribing and patient care indicators assessing 2640 prescriptions and clients respectively. Data were analyzed and presented as frequency with percentage or mean with standard deviation, as applicable. The performances of the types of PHCs were compared using two-sample t-test. A 2-tailed p-value < 0.05 was considered statistically significant. Results average number of drugs per prescription, drugs prescribed by the generic name, percentage of encounters with prescribed antibiotics and injections were 3.6 ± 0.9%, 76.5 ± 18.5%, 63.3 ± 19.1% and 21.1 ± 24.1% respectively with no significance difference between the comprehensive and basic PHCs. For all the facilities, the average consultation and dispensing times were 10.5 ± 6.0 minutes, 244.9 ± 179.2 seconds respectively. In this study, the percentage of patients' knowledge of the correct dosage was 72.4 ± 38.3%. There is statistically significant difference in availability of key drugs in stock between the comprehensive and basic PHCs (p-value 0.0001). Conclusion irrational drug use practices exist in comprehensive and basic PHCs. There is a need to implement interventions aimed at strengthening good prescribing and patient-care practices across the PHCs in Lagos State.
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Affiliation(s)
- Shakirat Adeshiyan Adeosun
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria,Corresponding author: Shakirat Adeshiyan Adeosun, Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria.
| | - Arinola Eniola Joda
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria
| | | | - Olubukola Olusola Oyetunde
- Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos, Idiaraba, Lagos State, Nigeria
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Sehmi K, Wale JL. Where National Medicines Policies Have Taken Us With Patient Involvement and Health Technology Assessment in Africa. Front Med Technol 2022; 4:810456. [PMID: 35281672 PMCID: PMC8915114 DOI: 10.3389/fmedt.2022.810456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
The Covid-19 pandemic has highlighted global knowledge about, but lack of equitable access to, life-changing medicines, and other innovative medical products by populations in African low and middle income countries. The World Health Organization (WHO) and other international non-profit foundations and organizations are constantly striving to address inequity. In the 1970s, WHO initiated a regularly updated essential medicines list, together with the concept of national medicines policies (NMPs) to ensure access and availability, affordability, rational, and effective use of medicines which are considered essential in addressing predominant population health issues and disease burden. We studied the NMPs of Ghana, South Africa, Uganda and Zimbabwe to highlight some of the important issues that these countries experience in the safe and effective use of medical products. Thailand is an example of how health technology assessment (HTA) can provide a country with an internationally supported, clearly defined and transparent process to broaden access to medicines and services. These medical services can add considerable value in accordance with local values and priorities. Involvement of civil society adds democratic legitimacy to such processes. Community health workers and patient advocacy groups are important in raising awareness and knowledge of safety issues and the effective use of quality medicines. They can apply pressure for increased funding to improve access to healthcare. Medicines and services that contribute to supported self-care are of benefit in any setting. Joint efforts across African countries such as with the African Medicines Agency are important in addressing some of the major health issues.
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Affiliation(s)
- Kawaldip Sehmi
- International Alliance of Patients' Organizations, London, United Kingdom
| | - Janet L. Wale
- HTAi Patient and Citizen Involvement Interest Group (PCIG), Brunswick, VIC, Australia
- *Correspondence: Janet L. Wale
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Yezli S, Yassin Y, Mushi A, Almuzaini Y, Khan A. Pattern of utilization, disease presentation, and medication prescribing and dispensing at 51 primary healthcare centers during the Hajj mass gathering. BMC Health Serv Res 2022; 22:143. [PMID: 35115010 PMCID: PMC8815220 DOI: 10.1186/s12913-022-07507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The majority of pilgrims seeking healthcare during Hajj are seen at primary healthcare centers (PHCCs). Data on the utilization of these facilities during Hajj can aid in directing optimal health services delivery and allocation of resources during the pilgrimage. Method We investigated the pattern of disease presentation, caseload, and medication prescribing and dispensing at 51 PHCCs during the 2019 Hajj. Data on patients’ demographics, diagnoses, and prescribed medications were retrieved from each PHCC’s electronic records and analyzed. Data were also used to calculate six of the World Health Organization (WHO) indicators for drug use at these facilities. Results Data were captured for 99,367 patients who were mostly Hajj pilgrims (95.4%), male (69.1%) from the Eastern Mediterranean (60.8%) and had a mean age of 46.6 years (SD = 14.9). Most patients (85.2%) were seen in Mina and towards the end of Hajj. The majority of patients (96.0%) had a single diagnosis; most commonly, respiratory (45.0%), musculoskeletal (17.2%), and skin (10.5%) diseases. Patients were prescribed 223,964 medications, mostly analgesics (25.1%), antibacterials for systemic use (16.5%), anti-inflammatory and antirheumatic products (16.4%), and cough and cold preparations (11.9%). On average, 2.25 (SD = 0.94) medications were prescribed per consultation, with low (1.3%) prevalence of polypharmacy. An antibiotic and an injectable were prescribed in 43.6 and 2.67% of patient encounters, respectively. Most (92.7%) of the prescribed drugs were actually dispensed, in an average time of 8.06 min (SD = 41.4). All PHCCs had a copy of the essential drugs list available, on which all the prescribed drugs appeared. Conclusion Respiratory illnesses are the main reason for PHCCs visits during Hajj, and analgesics and antibiotics are the most common medications prescribed to pilgrims. Our results, including the calculated WHO drug use indicators, contribute to evidence-based optimization of primary healthcare services during Hajj.
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Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yasir Almuzaini
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Baraka MA, Alboghdadly A, Alshawwa S, Elnour AA, Alsultan H, Alsalman T, Alaithan H, Islam MA, El-Fass KA, Mohamed Y, Alasseri AA, Fahelelbum KM. Perspectives of Healthcare Professionals Regarding Factors Associated with Antimicrobial Resistance (AMR) and Their Consequences: A Cross Sectional Study in Eastern Province of Saudi Arabia. Antibiotics (Basel) 2021; 10:878. [PMID: 34356799 DOI: 10.3390/antibiotics10070878] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Factors reported in the literature associated with inappropriate prescribing of antimicrobials include physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians’ decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing antimicrobials would minimize the risk of resistance and, consequently, improve patients’ clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. A cross-sectional study was conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed, validated, and piloted survey specific with closed-ended questions. A value of p < 0.05 was considered to be statistically significant. All data analysis was performed using the Statistical Package for Social Sciences (IBM SPSS version 23.0). 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All of the respondents acknowledged effectiveness, previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) as being key factors influencing physicians’ choice during antimicrobial prescribing. The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials were reported to be common practices. Furthermore, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials, and the use of antimicrobials without a physician’s prescription (i.e., self-medication) represent key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.
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Wiedenmayer K, Ombaka E, Kabudi B, Canavan R, Rajkumar S, Chilunda F, Sungi S, Stoermer M. Adherence to standard treatment guidelines among prescribers in primary healthcare facilities in the Dodoma region of Tanzania. BMC Health Serv Res 2021; 21:272. [PMID: 33761948 PMCID: PMC7990379 DOI: 10.1186/s12913-021-06257-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/08/2021] [Indexed: 01/09/2023] Open
Abstract
Background Tanzania’s primary healthcare system suffers from a scarcity of financial and human resources that impedes its effectiveness to deliver dependable and uniform quality healthcare. Adherence to standard treatment guidelines (STG) can help provide more consistent and correct diagnoses and treatments and limit the irrational use of medicines and the negative health consequences that can occur as a result. The purpose of this study was to investigate prescribers’ adherence of their diagnoses and respective treatments to national STG and to identify potential areas for planning interventions. Methods A cross-sectional study on prescribers’ adherence to diagnosis and treatment, according to national STG, was conducted in 2012 in public primary healthcare facilities (HCF) in the Dodoma region of Tanzania. Information on 2886 patients was collected, prospectively and retrospectively, from 120 HCF across the Dodoma region using a structured questionnaire. Twenty-five broadly defined main illness groups were recorded and the nine most prevalent and relevant conditions were statistically analysed in detail. Results Diagnoses and related treatments were recorded and analysed in 2872 cases. The nine most prevalent conditions were upper respiratory tract infections (25%), malaria (18%), diarrhoea (9.9%), pneumonia (6.1%), skin problems (5.8%), gastrointestinal diagnoses (5%), urinary tract infections (4%), worm infestations (3.6%) and eye problems (2.1%). Only 1.8% of all diagnoses were non-communicable diseases. The proportion of prescribers’ primary diagnoses that completely adhered to national STG was 599 (29.9%), those that partially adhered totalled 775 (38.7%), wrong medication was given in 621 cases (30.9%) and no diagnosis or medication was given in nine cases (0.5%). Sixty-one percent of all patients received an antibiotic regardless of the diagnoses. Complete adherence was highest when worms were diagnosed and lowest for diarrhoea. The proportion of cases that did not adhere to STG was highest with patients with skin problems and lowest for malaria. Conclusion Prescribers’ general adherence to national STG in primary HCF in the public sector in Dodoma region is sub-optimal. The reasons are multifaceted and focused attention, directed at improving prescribing and pharmacotherapy, is required with a view of improving patient care and health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06257-y.
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Affiliation(s)
- Karin Wiedenmayer
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
| | - Eva Ombaka
- St. John's University Tanzania, Dodoma, Tanzania
| | - Baraka Kabudi
- Mission for Essential Medical Supplies, P.O. Box 1005, Arusha, Tanzania
| | - Robert Canavan
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Sarah Rajkumar
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Fiona Chilunda
- Health Promotion and System Strengthening project, Dodoma, Tanzania
| | | | - Manfred Stoermer
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
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Maiga Y, Sangho O, Konipo F, Diallo S, Coulibaly SDP, Sangare M, Péréon Y, Giumelli B, Sanou M, Coulibaly A, Diallo S, Daou M, Traoré Z, Albakaye M, Traoré HA, Guinto CO, Ouologem M, Kuate-Tegueu C, Bouhassira D, Cowan R, Nizard J. Neuropathic pain in Mali: The current situation, comprehensive hypothesis, which therapeutic strategy for Africa? eNeurologicalSci 2021; 22:100312. [PMID: 33537467 PMCID: PMC7841313 DOI: 10.1016/j.ensci.2021.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION According to the taxonomy of the International Association for the Study of Pain (IASP 2011), neuropathic pain (NeuP) is defined as "pain caused by a lesion or disease of the somatosensory nervous system". NeuP is currently well-defined clinically, despite a high degree of etiological variation, and it has become a significant public health problem. This work aimed to study the situation regarding NeuP in current practice in Mali, as well as to analyze the therapeutic environment of the patients. METHODOLOGY This was a retrospective and cross-sectional study, carried out in two phases: (1) compilation of the files of patients according to the ICD-11, over a period of 24 months (2) a second prospective phase regarding the Knowledge, Attitudes, and Practices (KAP) of general practitioners and neurologists in regard to NeuP. The focus of the first phase of the study was the files of the patients who had undergone a consultation at the Gabriel Touré UHC. The second phase of the study focused on the general practitioners (Community Health Centers (comHC) of Bamako) and neurologists (Malian or not). RESULTS Over the period of the study, 7840 patients were seen in consultation in the Department of Neurology, of whom 903 for NeuP, thus amounting to a NeuP frequency of 11.5%. Women accounted for 58.9% (532/903), with a sex ratio of 1.4. Using a comparative normal law, the difference in frequency was statistically significant between males and females (p < 10-7) and between two age groups (p 〈10-3). The 49-58 years of age group was represented the most. Diabetic NeuP (21%), lumbar radiculopathies (14%), HIV/AIDS NeuP (13%), and post-stroke NeuP (11%) were the most represented. The survey among the carers revealed: a need for training, a low level of compliance with the therapeutic guidelines, and the use of traditional medicine by the patients. DISCUSSION/CONCLUSION This work confirms that NeuP is encountered frequently in current practice, and its optimal management will involve specific training of carers and improvement of access to the medications recommended in this indication. In light of this issue, we revisit the debate regarding the concept of essential medications and the relevance of taking into account effective medications for the treatment of NeuP.
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Affiliation(s)
- Youssoufa Maiga
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
- Laboratoire de Thérapeutique (EA3826), Faculté de Médecine de Nantes, Nantes, France
| | - Oumar Sangho
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Fatoumata Konipo
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Seybou Diallo
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | | | - Modibo Sangare
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Yann Péréon
- Laboratoire d'Explorations Fonctionnelles, Centre de Référence Maladies Neuromusculaires Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, CHU de Nantes, France
| | | | - Martin Sanou
- Faculté de Chirurgie Dentaire, Université de Nantes, France
| | - Awa Coulibaly
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Salimata Diallo
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Mariam Daou
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | | | - Mohamed Albakaye
- Department of Neurology, Gabriel Touré Teaching Hospital, Bamako, Mali
| | - Hamar A. Traoré
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Cheick Oumar Guinto
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | | | - Callixte Kuate-Tegueu
- Département de Médecine Interne et Spécialités, FMSB, Université de Yaoundé 1, Cameroon
| | - Didier Bouhassira
- INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92 100 Boulogne-Billancourt, France
| | - Robert Cowan
- Department of Neurology, Stanford University, California, USA
| | - Julien Nizard
- Laboratoire de Thérapeutique (EA3826), Faculté de Médecine de Nantes, Nantes, France
- Centre Fédératif Douleur Soins Palliatifs et Support, Laboratoire de Thérapeutique, CHU Nantes, Nantes, France
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Waleekhachonloet O, Rattanachotphanit T, Limwattananon C, Thammatacharee N, Limwattananon S. Effects of a national policy advocating rational drug use on decreases in outpatient antibiotic prescribing rates in Thailand. Pharm Pract (Granada) 2021; 19:2201. [PMID: 33628347 PMCID: PMC7886315 DOI: 10.18549/pharmpract.2021.1.2201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/24/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: This study examined the effects of a national policy advocating rational drug
use (RDU), namely, the ‘RDU Service Plan’, starting in fiscal
year 2017 and implemented by the Thai Ministry of Public Health (MOPH), on
trends in antibiotic prescribing rates for outpatients. The policy was
implemented subsequent to a voluntary campaign involving 136 hospitals,
namely, the ‘RDU Hospital Project’, which was implemented
during fiscal years 2014-2016. Methods: Hospital-level antibiotic prescribing rates in fiscal years 2014-2019 for
respiratory infections, acute diarrhea, and fresh wounds were aggregated for
two hospital groups using equally weighted averages: early adopters of RDU
activities through the RDU Hospital Project and late adopters under the RDU
Service Plan. Pre-/post-policy annual changes in the prescribing levels and
trends were compared between the two groups using an interrupted time-series
analysis. Results: In fiscal years 2014-2016, decreases in antibiotic prescribing rates for
respiratory infections and acute diarrhea in both groups reflected a trend
that existed before the RDU Service Plan was implemented. The immediate
effect of the RDU Service Plan policy occurred in fiscal year 2017, when the
prescribing level among the late adopters dropped abruptly for all three
conditions with a greater magnitude than in the decrease among the early
adopters, despite nonsignificant differences. The medium-term effect of the
RDU Service Plan was identified through a further decreasing trend during
fiscal years 2017-2019 for all conditions in both groups, except for acute
diarrhea among the early adopters. Conclusions: The national policy on rational drug use effectively reduced antibiotic
prescribing for common but questionable outpatient conditions.
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Affiliation(s)
| | | | | | | | - Supon Limwattananon
- PhD. Faculty of Pharmaceutical Sciences, Khon Kaen University. Khon Kaen (Thailand).
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Carey N, Boersema GC, du Toit HS. Improving early detection of infection in nursing home residents in South Africa. Int J Afr Nurs Sci 2021; 14:100288. [PMID: 33520656 PMCID: PMC7830222 DOI: 10.1016/j.ijans.2021.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/21/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
This paper sets out key challenges related to detection and management of infection in nursing home residents, and then explores the situation in South Africa, and use of decision support tools as a mechanism to improve this area of practice. In line with global trends, concerns have been raised about the rapidly increasing aging population in South Africa and the ability of the current healthcare system to keep pace with patient demand, particularly nursing home residents. Nursing home residents, who often exhibit atypical signs and symptoms, are at increased risk of infection and unplanned admissions, which account for 65% of all bed days, and cost the US healthcare economy more than a trillion dollars a year. Evidence suggests that the current workforce in South Africa receive limited training in this area and are largely unprepared to meet the demands of the aging population. Building the capacity and skills of the workforce in South Africa is one approach that could help to improve the early detection of infection and assist the nursing home workforce to provide more effective and timely care, particularly during the current COVID-19 pandemic. Decision support tools, such as the Early Detection of Infection Scale, can help ensure consistency and ensure more timely treatment, minimising unplanned admissions and healthcare expenditure. However, the potential benefits or indeed how easily this could be integrated in to nursing homes in South Africa is unknown. An important first step, as in other parts of the world, is therefore to explore views and opinions of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes.
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Affiliation(s)
- Nicola Carey
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Kate Granger Building, Priestly Road, Surrey Research Park, Guildford, Surrey GU2 7YH, United Kingdom
| | | | - Helena S du Toit
- Department of Health Studies, University of South Africa, PO Box 392, Unisa, Pretoria, 0003, South Africa
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Perehudoff K, Demchenko I, Alexandrov NV, Brutsaert D, Ackon A, Durán CE, El-Dahiyat F, Hafidz F, Haque R, Hussain R, Salenga R, Suleman F, Babar ZUD. Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries. Int J Environ Res Public Health 2020; 17:E9524. [PMID: 33353250 PMCID: PMC7765934 DOI: 10.3390/ijerph17249524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022]
Abstract
Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives (n = 14 articles), health equity (n = 10), information dissemination (n = 3), infrastructure (n = 2), and sanctions (n = 1) (not mutually exclusive). Cross-sectional descriptive designs (n = 8 articles) and time series analyses (n = 5) were the most frequent designs. Change in patients' spending on medicines was the most frequent outcome measure (n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated.
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Affiliation(s)
- Katrina Perehudoff
- Law Center for Health and Life, University of Amsterdam, 1018 WV Amsterdam, The Netherlands
- Department of Public Health & Primary Care, Ghent University, 9000 Gent, Belgium;
- WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, University of Toronto, 144 College Street, Toronto, ON M5S 3M2, Canada
| | - Ivan Demchenko
- Forensic Medicine and Medical Law Department, National Medical University ‘O.O. Bogomolec’, 01601 Kyiv, Ukraine;
| | - Nikita V. Alexandrov
- Global Health Law Groningen Research Centre, Department of Transboundary Legal Studies, Faculty of Law, University of Groningen, 9700 AS Groningen, The Netherlands;
| | - David Brutsaert
- Department of Public Health & Primary Care, Ghent University, 9000 Gent, Belgium;
| | - Angela Ackon
- Directorate of Pharmacy, Ministry of Health, P. O. Box M 44 Accra, Ghana;
| | - Carlos E. Durán
- Clinical Pharmacology Research Group, Department of Basic & Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium;
| | | | - Firdaus Hafidz
- Department of Health Policy & Management, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia;
| | - Rezwan Haque
- Access to Information (a2i) Programme (Former Project Director, SWASTI), Dhaka 1207, Bangladesh;
- Department of Pharmacy (Adjunct), Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh
| | - Rabia Hussain
- Faculty of Pharmacy, The University of Lahore, Lahore 54590, Pakistan;
- Commonwealth Pharmacists Association, London E1W 1AW, UK
| | - Roderick Salenga
- College of Pharmacy, University of the Philippines Manila, Metro Manila 1000, Philippines;
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa;
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK;
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Richards GC, Aronson JK, Heneghan C, Mahtani KR, Koshiaris C, Persaud N. Relation between opioid consumption and inclusion of opioids in 137 national essential medicines lists. BMJ Glob Health 2020; 5:e003563. [PMID: 33173012 PMCID: PMC7656944 DOI: 10.1136/bmjgh-2020-003563] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Opioids are deemed essential medicines by the World Health Organization (WHO). However, many countries have inadequate access to them. Whether including opioids in national essential medicines lists (EMLs) influences national opioid consumption has not been evaluated. METHODS We conducted a cross-sectional study to determine whether the listing of opioids in national EMLs was associated with consumption. We quantified the numbers and types of all opioids included in 137 national EMLs, for comparison with opioids in the WHO's Model List of Essential Medicines. Using the International Narcotics Control Board (INCB) consumption statistics for 2015-2017, we assessed the relation between annual mean opioid consumption (mg/person) and the numbers of opioids included in EMLs, controlling for region, population, healthcare expenditure, life expectancy, gross domestic product, human development and corruption. RESULTS Five opioids were included in the 20th edition of the WHO's Model List of Essential Medicines: codeine, fentanyl, loperamide, methadone and morphine. On average, countries' lists included significantly (p<0.05) more opioids than the WHO's Model List. However, there were wide variations in the numbers (median 6 opioids; IQR: 5-9) and types (n=33) of opioids included in national EMLs. Morphine (95%), fentanyl (83%) and codeine (69%) were the most commonly included opioids. Most national EMLs were out of date (median publication date: 2011, IQR: 2009-2013). After adjusting for country characteristics, there was no relation between mean opioid consumption and the number of opioids in EMLs. CONCLUSIONS Including opioids in national EMLs was not associated with consumption. National EMLs should be regularly updated to reflect the availability of opioids and the populations' needs for managing pain.
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Affiliation(s)
- Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Constantinos Koshiaris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Nav Persaud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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Carey N, Alkhamees N, Cox A, Sund-Levander M, Tingström P, Mold F. Exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and manager's in nursing homes in England and Sweden: a survey protocol. BMJ Open 2020; 10:e038390. [PMID: 33004397 PMCID: PMC7534694 DOI: 10.1136/bmjopen-2020-038390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic.We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden. METHODS AND ANALYSIS An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents. ETHICS AND DISSEMINATION This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information.This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost-benefit analyses as the work progresses.
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Affiliation(s)
- N Carey
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Nouf Alkhamees
- College of Health and Rehabilitation Sciences, Princess Noura Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Anna Cox
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Marta Sund-Levander
- Division of Nursing, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Pia Tingström
- Division of Nursing, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Freda Mold
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Yezli S, Zaraa S, Yassin Y, Mushi A, Stergachis A, Khan A. Medication utilization pattern among outpatients during the Hajj mass gathering. Saudi Pharm J 2020; 28:1122-1128. [PMID: 32922144 PMCID: PMC7474167 DOI: 10.1016/j.jsps.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/28/2020] [Indexed: 01/20/2023] Open
Abstract
Background The Kingdom of Saudi Arabia (KSA) provides free healthcare, including medications, for the over 2 million Muslim pilgrims who attend Hajj every year. Information on drug utilization patterns at the Hajj is important to strengthen the supply chain for medicines, avert stock-outs, identify inappropriate use, and support public health planning for the event. Method We investigated drug utilization pattern among outpatients in eight seasonal Holy sites hospitals in Makkah, KSA, during the 2018 Hajj. Data on medication prescribed and dispensed were retrieved from the hospitals' electronic records. Data were also used to calculate six of the WHO indicators for drug use at these facilities. Results A total of 99,117 medications were prescribed for 37,367 outpatients during 37,933 encounters. Outpatients were mainly older males and originated from 134 countries. Twenty medications accounted for 72.8% of the 323 different medications prescribed. These were mainly nonsteroidal anti-inflammatory drugs, analgesics and antipyretics, and antibacterial medicines for systemic use. Outpatients were prescribed an average of 2.6 (SD = 1.2) drugs per consultation and polypharmacy (≥5 medications) was observed in 4.8% of the encounters. Antibiotics and an injection were prescribed in 46.9% and 6.5% of encounters, respectively. Nearly 90% of the prescribed drugs were actually dispensed. On average, medications were dispensed 16.4 (SD = 119.8) minutes from the time they were prescribed for the patient. All hospitals had a copy of the essential drugs list available and all of the prescribed drugs appeared on that list. Conclusion Nonsteroidal anti-inflammatory drugs, analgesics and antibiotics are the most common medications prescribed to outpatient during Hajj. Our results, including the calculated WHO drug use indicators, can form a basis for further investigations into appropriate drug use at the Hajj and for planning purposes. These results could also guide the development of reference values for medications prescribing and use indicators at mass gatherings.
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Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Sabra Zaraa
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Andy Stergachis
- School of Pharmacy, University of Washington, Seattle, WA, USA.,School of Public Health, University of Washington, Seattle, WA USA
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Khan M, Ullah R, Khan A, Ur-Rahman N, Khan S, Riaz M. Assessment of Prescriptions in the Endocrinology Department of a Tertiary Care Hospital in Pakistan Using World Health Organization Guidelines. Adv Prev Med 2020; 2020:3705704. [PMID: 32551141 DOI: 10.1155/2020/3705704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background It is essential to follow World Health Organization drug prescribing indicators to ensure rational prescribing in every health care setting. Objective To evaluate the prescriptions in the endocrinology department, according to the World Health Organization (WHO), recommended Ghana guidelines for diabetes management and rational therapy. Methods Concurrent and retrospective study design was used. The prescriptions of 100 diabetes patients were assessed for the type of medicine, dosage form, number of drugs, diabetes type, and deviation from standard guidelines. Results In a total of 100 prescriptions, the pattern was reported as injections (31%), antibiotics (18%), and metformin (31.1%). Half of the prescriptions were according to WHO guidelines. The number of drugs per prescription was reported at 5.2. A 70% rational approach was followed in prescribing. 81% of drugs were prescribed from the Essential Drug List (EDL) of the WHO. However, the National Essential Drug List (NEDL) was followed by 27%. The percentage of drugs on generic names was 0.7%. Eighty-four patients showed net improvement in health; 16 patients showed higher glycemic range at the time of discharge. Conclusion The conclusion of the present study indicates that WHO Ghana guidelines were not followed up to the mark to improve the overall health status of diabetic patients and rational prescribing.
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Nyabuti AO, Okalebo FA, Guantai EM. Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya. Adv Pharmacol Pharm Sci 2020; 2020:3173847. [PMID: 32647831 DOI: 10.1155/2020/3173847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
Background Irrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study sets out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology. Methods Ten PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use. Results The average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6–1.8), and the percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%), and the percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available. Conclusion The survey shows irrational drug use practices, particularly polypharmacy, nongeneric prescribing, overuse of antibiotics, short consultation time, and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.
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Holloway KA, Ivanovska V, Manikandan S, Jayanthi M, Mohan A, Forte G, Henry D. Identifying the most effective essential medicines policies for quality use of medicines: A replicability study using three World Health Organisation data-sets. PLoS One 2020; 15:e0228201. [PMID: 32027679 PMCID: PMC7004360 DOI: 10.1371/journal.pone.0228201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Poor quality use of medicines (QUM) has adverse outcomes. Governments’ implementation of essential medicines (EM) policies is often suboptimal and there is limited information on which policies are most effective. Methods We analysed data on policy implementation from World Health Organisation (WHO) surveys in 2007 and 2011, and QUM data from surveys during 2006–2012 in developing and transitional countries. We compared QUM scores in countries that did or did not implement specific policies and regressed QUM composite scores on the numbers of policies implemented. We compared the ranking of policies in this and two previous studies, one from the same WHO databases (2003–2007) the other from data obtained during country visits in South-East Asia (2010–2015). The rankings of a common set of 17 policies were correlated and we identified those that were consistently highly ranked. Findings Fifty-three countries had data on both QUM and policy implementation. Forty policies were associated with effect sizes ranging from +13% to -5%. There was positive correlation between the composite QUM indicator and the number of policies reported implemented: (r) = 0.437 (95% CI 0.188 to 0.632). Comparison of policy rankings between the present and previous studies showed positive correlation with the WHO 2003–7 study: Spearman’s rank correlation coefficient 0.498 (95% CI 0.022 to 0.789). Across the three studies, five policies were in the top five ranked positions 11 out of a possible 15 times: drugs available free at the point of care; a government QUM unit; undergraduate training of prescribers in standard treatment guidelines, antibiotics not available without prescription and generic substitution in the public sector. Interpretation Certain EM policies are associated with better QUM and impact increases with co-implementation. Analysis across three datasets provides a policy short-list as a minimum investment by countries trying to improve QUM and reduce antimicrobial drug misuse.
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Affiliation(s)
- Kathleen Anne Holloway
- Health and Nutrition, Institute of Development Studies, University of Sussex, Brighton, England, United Kingdom of Great Britain
- * E-mail:
| | - Verica Ivanovska
- Essential Medicines and Health Products, World Health Organisation, Geneva, Switzerland
| | - Solaiappan Manikandan
- Department of Pharmacology, Jawarhalal Nehru Institute of Medical Education and Research, Puducherry, India
| | - Mathaiyan Jayanthi
- Department of Pharmacology, Jawarhalal Nehru Institute of Medical Education and Research, Puducherry, India
| | - Anbarasan Mohan
- Department of Pharmacology, Government Theni Medical College, Theni, Tamil Nadu, India
| | - Gilles Forte
- Essential Medicines and Health Products, World Health Organisation, Geneva, Switzerland
| | - David Henry
- Institute for Evidence-based Healthcare, Bond University, Gold Coast, Queensland, Australia
- University of Melbourne, Melbourne, Australia
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Umar L, Isah A, Musa S, Umar B. Outpatient prescribing and antibiotic use for children in a tertiary hospital. Sahel Med J 2020. [DOI: 10.4103/smj.smj_27_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Charles O, Onakpoya I, Benipal S, Woods H, Bali A, Aronson JK, Heneghan C, Persaud N. Withdrawn medicines included in the essential medicines lists of 136 countries. PLoS One 2019; 14:e0225429. [PMID: 31791048 PMCID: PMC6887519 DOI: 10.1371/journal.pone.0225429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Essential medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of medicines. The World Health Organization (WHO) recommends that countries carefully select the medicines to be included in their national essential medicines lists. Lists that are used to prioritize access to important treatments should not include medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national essential medicines lists of 137 countries include medicines that have been withdrawn in other countries. METHODS AND FINDINGS We performed an audit of national essential medicines lists for medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national medicines list, the number of withdrawn medicines included in each nation's list, and the number of national essential medicines including each withdrawn medicine. 97 medicines were withdrawn in at least one country but still included in one more national essential medicines list. Of 137 countries with a national essential medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn medicines, and 27% including 10 or more withdrawn medicines. 11 medicines were withdrawn worldwide but still included on at least one national essential medicines list. Countries with longer essential medicines lists had more withdrawn medicines included in their lists. CONCLUSIONS This study found that withdrawn medicines are included in all but one national essential medicines list, representing a need for more stringent processes for selecting and removing medicines on these lists. Countries may wish to apply special scrutiny to medicines withdrawn in other nations when selecting medicines to include on their lists.
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Affiliation(s)
- Onella Charles
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Igho Onakpoya
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simran Benipal
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Hannah Woods
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Anjli Bali
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Jeffrey K. Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nav Persaud
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario
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Amadi C, Tsui EK. How the quality of essential medicines is perceived and maintained through the pharmaceutical supply chain: A perspective from stakeholders in Nigeria. Res Social Adm Pharm 2019; 15:1344-1357. [DOI: 10.1016/j.sapharm.2018.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 01/25/2023]
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Wogayehu B, Chisha Y, Tekabe B, Adinew A, Asefaw M. A cross sectional comparison of drug use indicators using WHO methodology in primary level hospitals participating in an Auditable Pharmaceutical Transactions and Services program versus non-APTS primary hospitals in Southern Ethiopia. PLoS One 2019; 14:e0223523. [PMID: 31589641 PMCID: PMC6779258 DOI: 10.1371/journal.pone.0223523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Ethiopian pharmaceutical sector has been facing inaccessibility and unaffordability to key essential medicines due to medicines diversion from the public to private health care facilities, lack of transparency, poor inventory management, and poor dispensing workflow. In an effort to improve the pharmaceutical sector, the government of Ethiopia in 2011 introduced Auditable Pharmaceutical Transactions and Services program. This study intended to compare drug use indicators in auditable and non-auditable primary level hospitals. METHODS A cross-sectional comparative study was conducted between January 2018 and December 2018 at primary level hospitals in southern Ethiopia: one with Auditable Pharmaceutical Transactions and Services (APTS) program; another without APTS (Non-APTS).WHO drug use indicators in auditable primary hospitals (n = 10) and similar non-auditable primary hospitals (n = 10) were compared. The prescribing indicators and average cost of medicines were evaluated retrospectively using 1000 prescriptions from each group. Patient care indicators were evaluated prospectively by interviewing and observing 1000 patients from each group. Patient satisfaction was assessed by interviewing 1000 patients from each group. Health care facilities were evaluated through observation. We performed descriptive analysis, t-test, logistic regression, Mann-Whitney U test and linear regression using SPSS version 20.0. RESULTS The mean consultation time in auditable and non-auditable hospitals was found to be 6.5 minutes and 3.46 minutes, respectively. The average dispensing time in auditable and non-auditable hospitals was found to be 6.6 minutes and 1.02 minutes, respectively.The proportion of drugs actually dispensed was 97.59% in APTS facilities and 76.44% in the non-auditable facilities with the lowest value seen in a non-auditable facility (51.65%). The average number of drugs per prescription was 2.32 (±1.26) and 2.84 (±1.17) in auditable and non-auditable facilities, respectively. The level of patient satisfaction on the convenience of pharmacy location, information on contraindications, availability of drugs and amount of time for counseling was significantly higher in the auditable facilities than the non-auditable facilities (p<0.001). CONCLUSIONS This study revealed that patient care indicator values, the level of patient satisfaction on the pharmacy services and health facility indicator values were significantly better in APTS than Non-APTS primary level hospitals. Most of prescribing indicators and labeling practices were not met WHO stated standard in both auditable and non-auditable facilities.This indicates that the auditable programshould include additional strategies to reverse the existing irrational prescribing and inadequate labeling practices.
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Affiliation(s)
- Biruk Wogayehu
- Department of Pharmacy, Arbaminch College of Health Sciences, Arbaminch, Ethiopia
- * E-mail:
| | - Yilma Chisha
- Department of Public Health, Arbaminch University, Arbaminch, Ethiopia
| | - Be’emnetu Tekabe
- Department of Public Health, Arbaminch University, Arbaminch, Ethiopia
| | - Ayalew Adinew
- Pharmacy Service, Federal Ministry of Health, Addis Ababa, Ethiopia
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Perehudoff SK, Alexandrov NV, Hogerzeil HV. The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries. PLoS One 2019; 14:e0215577. [PMID: 31251737 PMCID: PMC6599146 DOI: 10.1371/journal.pone.0215577] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/04/2019] [Indexed: 11/18/2022] Open
Abstract
Persistent barriers to universal access to medicines are limited social protection in the event of illness, inadequate financing for essential medicines, frequent stock-outs in the public sector, and high prices in the private sector. We argue that greater coherence between human rights law, national medicines policies, and universal health coverage schemes can address these barriers. We present a cross-national content analysis of national medicines policies from 71 countries published between 1990-2016. The World Health Organization's (WHO) 2001 guidelines for developing and implementing a national medicines policy and all 71 national medicines policies were assessed on 12 principles, linking a health systems approach to essential medicines with international human rights law for medicines affordability and financing for vulnerable groups. National medicines policies most frequently contain measures for medicines selection and efficient spending/cost-effectiveness. Four principles (legal right to health; government financing; efficient spending; and financial protection of vulnerable populations) are significantly stronger in national medicines policies published after 2004 than before. Six principles have remained weak or absent: pooling user contributions, international cooperation, and four principles for good governance. Overall, South Africa (1996), Indonesia and South Sudan (2006), Philippines (2011-2016), Malaysia (2012), Somalia (2013), Afghanistan (2014), and Uganda (2015) include the most relevant texts and can be used as models for other settings. We conclude that WHO's 2001 guidelines have guided the content and language of many subsequent national medicines policies. WHO and national policy makers can use these principles and the practical examples identified in our study to further align national medicines policies with human rights law and with Target 3.8 for universal access to essential medicines in the Sustainable Development Goals.
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Affiliation(s)
- S. Katrina Perehudoff
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Nikita V. Alexandrov
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Hans V. Hogerzeil
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Makki M, Hassali MA, Awaisu A, Hashmi F. The Prevalence of Unused Medications in Homes. Pharmacy (Basel) 2019; 7:pharmacy7020061. [PMID: 31200530 PMCID: PMC6631141 DOI: 10.3390/pharmacy7020061] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 12/17/2022] Open
Abstract
The prevalence of unused medications in homes has dramatically increased in recent decades, which has resulted in medication wastage. The aim of this study is to review the prevalence of unused medications in homes and to determine the reasons behind this disuse, so as to help reduce such wastage. The review also sheds light on current methods of disposal of unwanted medications. Here, using a narrative review, we provide an overview of the issues of unused medications, medication wastage, and methods of disposal. We conducted an extensive literature search focusing on subject-related keywords, as given in the methods section below. A search was undertaken through indexing services available in the library of the authors’ institution. Full-text papers concerned with the prevalence of unused medications in homes, written in English language between 1992 and 2018, were retrieved and reviewed. Twenty-five related studies performed in different world regions were reviewed and included. The public, healthcare providers, and governments are all accused of promoting medication wastage in different ways, and thus, they need to be targeted to solve the problem. It was also noticed that the prevalence of unused medications is high in many countries. Non-steroidal anti-inflammatory drugs are among the most frequently wasted medications, and most of the public just dispose of their expired medications in the trash or toilet. Non-adherence, death, and medication change are among the main causes of medication accumulation and consequent wastage. A lack of policies to return unwanted medications in some countries, as well as public unawareness, carelessness, or illiteracy, are reasons for improper disposal of unused medications that may lead to adverse economic and environmental impacts. Various mitigation strategies (e.g., smart medicine cabinet) have emerged to reduce medication wastage. Joint work among the public, healthcare providers, and various governmental and private organizations is needed to adequately address the issue of medication wastage.
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Affiliation(s)
- Mutaseim Makki
- School of Pharmaceutical Sciences, University Sains Malaysia, Penang 11700, Malaysia.
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, University Sains Malaysia, Penang 11700, Malaysia.
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha 2713, Qatar.
| | - Furqan Hashmi
- College of Pharmacy, University of the Punjab, Lahore 54590, Pakistan.
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Arikan İ, Özyigit F. Evaluation of rational drug use knowledge level in patients with musculoskeletal disorders. J Back Musculoskelet Rehabil 2019; 32:119-124. [PMID: 30248041 DOI: 10.3233/bmr-181252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND For treatment of chronic musculoskeletal disorders pains to be successful, drug interventions are required. OBJECTIVE In this study, we aimed to evaluate the Rational Drug Use Knowledge Level (RDUKL) in patients with musculoskeletal disorders and some relevant factors. METHOD The study was carried out in October 2017 on patients treated in the Physical Therapy Rehabilitation Hospital in Turkey. The prepared questionnaire and RDUKL scale were administered to 239 patients by face-to-face interviews. The ANOVA test, chi-squared test and logistic regression model were used for the statistical evaluation. RESULTS Forty-three percent of the study group was found to have Rational Drug Use Knowledge (RDUK). The patients who used medicines under family supervision had twice as much RDUK as those who did not use medicines under family supervision, and those who were university graduates had six times as much RDUK as those who had primary education or below. Scale score was found to be low in patients with fibromyalgia and high in patients with rheumatoid arthritis (p< 0.05). CONCLUSION RDUKL was found to be low in the group with chronic diseases and high average age. Besides training, it is important to provide patients with family support about their illness and its treatment. Thus, positive contributions can be made to the increase of the RDUKL.
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Affiliation(s)
- İnci Arikan
- Department of Public Health, Medical Faculty of Kütahya Health Sciences University, Kütahya 43100, Turkey
| | - Filiz Özyigit
- Department of Pharmacology, Medical Faculty of Kütahya Health Sciences University, Kütahya 43100, Turkey
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Fernandes RA, Mantovani AM, Codogno JS, Turi-Lynch BC, Pokhrel S, Anokye N. The Relationship between Lifestyle and Costs Related to Medicine Use in Adults. Arq Bras Cardiol 2019; 112:749-755. [PMID: 30892384 PMCID: PMC6636366 DOI: 10.5935/abc.20190049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The unhealthy lifestyle is growing and this can have repercussions on health status demanding actions on the occurrence of diseases and leads to increased expenses. OBJECTIVE To examine the interrelationship between the costs of medicine use and lifestyle behaviors. METHODS A cohort study with 118 participants, age around 51.7 ± 7.1 years old. It was collected personal and anthropometric data and information about medicine of continuous use to calculate the costs. Lifestyle variables included habitual physical activity (PA) assessed by pedometer, sedentary behavior by Baecke questionnaire, sleep quality by mini sleep questionnaire and self-report of smoke and alcohol consumption. Statistical analyses were performed by BioEstat (version 5.2) and the significance level set at p-value < 0.05. RESULTS In 12 months, 62 subjects bought 172 medicines, representing an overall cost of US$ 3,087.01. Expenditures with drugs were negatively related to PA (r = -0.194, p-value = 0.035 and r = -0.281, p-value = 0.002), but positively related with sleep quality (r = 0.299, p-value=0.001 and r = 0.315, p-value = 0.001) and age (r = 0.274, p-value = 0.003). Four multivariate models were executed considering lifestyle behaviors in different moments of cohort and medicine costs, and all these models identify important relationship between lifestyle behaviors with expenditures with drugs. CONCLUSION Worse sleep quality seems to increase the costs related to medicine use in adults, while obesity and ageing play a relevant role in this phenomenon and alcohol consumption seems a variable with relevant economic impact.
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Affiliation(s)
- Romulo Araujo Fernandes
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil.,Departmento de Educação Física - Faculdade de Ciências e Tecnologia - Universidade Estadual Paulista (UNESP), Presidente Prudente, SP - Brazil
| | - Alessandra Madia Mantovani
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil
| | - Jamile Sanches Codogno
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil.,Departmento de Educação Física - Faculdade de Ciências e Tecnologia - Universidade Estadual Paulista (UNESP), Presidente Prudente, SP - Brazil
| | - Bruna Camilo Turi-Lynch
- Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), Rio Claro, SP - Brazil
| | - Subhash Pokhrel
- Institute of Environment - Health and Societies - Brunel University - Uxbridge, London - United Kingdom
| | - Nana Anokye
- Institute of Environment - Health and Societies - Brunel University - Uxbridge, London - United Kingdom
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Fadare JO, Ogunleye O, Obiako R, Orubu S, Enwere O, Ajemigbitse AA, Meyer JC, Enato E, Massele A, Godman B, Gustafsson LL. Drug and therapeutics committees in Nigeria: evaluation of scope and functionality. Expert Rev Clin Pharmacol 2018; 11:1255-1262. [PMID: 30451035 DOI: 10.1080/17512433.2018.1549488] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Inappropriate use of medicines remains a problem, with consequences including increasing adverse drug reactions (ADRs) and prolonged hospitalizations. The Essential Medicines List and Drug and Therapeutics Committees (DTCs) are accepted initiatives to promote the rational use of medicines. However, little is known about DTC activities in Nigeria, the most populous African country. Areas covered: A cross-sectional questionnaire-based study was conducted among senior pharmacists, consultant physicians, and clinical pharmacologists in 12 leading tertiary health-care facilities across Nigeria. Expert commentary: Six (50%, 6/12) health-care facilities had existing DTCs with three (50%) having a subcommittee on antimicrobials. Seventy-five percent had infection control committees, with presence even in centers without DTCs. Chairpersons and secretaries of the DTCs were predominantly physicians (83.3%) and pharmacists (100%), respectively. Hospital formularies were available in five facilities with DTCs, while one facility without a DTC had an Essential Medicines Committee responsible for developing and updating the hospital formulary. The evaluation of ADRs was undertaken by pharmacovigilance units in nine facilities. Overall, DTCs were present in only half of the surveyed facilities and most were performing their statutory functions sub-optimally. The functioning of DTCs can be improved through government directives and mechanisms for continuous evaluation of activities.
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Affiliation(s)
- Joseph O Fadare
- a Department of Pharmacology and Therapeutics, College of Medicine , Ekiti State University , Ado-Ekiti , Nigeria
| | - Olayinka Ogunleye
- b Department of Pharmacology and Medicine , Lagos State University College of Medicine and the Teaching Hospital , Ikeja , Nigeria
| | - Reginald Obiako
- c Department of Medicine, Clinical Pharmacology Unit , Ahmadu Bello University , Zaria , Nigeria
| | - Samuel Orubu
- d Faculty of Pharmacy , Niger Delta University , Wilberforce Island , Bayelsa State , Nigeria
| | - Okezie Enwere
- e Department of Medicine , Imo State University , Orlu , Nigeria
| | | | - Johanna C Meyer
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Ehijie Enato
- h Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy , University of Benin , Benin City , Nigeria
| | - Amos Massele
- i Department of Clinical Pharmacology, School of Medicine , University of Botswana , Gaborone , Botswana
| | - Brian Godman
- g Department of Public Health Pharmacy and Management, School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa.,j Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden.,k Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Lars L Gustafsson
- j Division of Clinical Pharmacology, Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden
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Gashaw T, Sisay M, Mengistu G, Amare F. Investigation of prescribing behavior at outpatient settings of governmental hospitals in eastern Ethiopia: an overall evaluation beyond World Health Organization core prescribing indicators. J Pharm Policy Pract 2018; 11:26. [PMID: 30364357 PMCID: PMC6194689 DOI: 10.1186/s40545-018-0152-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/20/2018] [Indexed: 01/05/2023] Open
Abstract
Background Rational prescribing remains an important component of rational drug use. The World Health Organization (WHO) standardized and validated core prescribing indicators for evaluating prescribing pattern of drugs. The prescribing practice has been shown to deviate from national and WHO guidelines in Ethiopia. The aim of this study was; therefore, to investigate the overall prescribing behavior of four governmental hospitals: Hiwot Fana Specialized University Hospital (HFSUH), Federal Harar Police Hospital (FHPH), Jugel Hospital (JH) and Southeast Command III Hospital (SECIIIH), Harar, eastern Ethiopia. Methods Hospital based retrospective cross-sectional study was employed to evaluate outpatient prescriptions dispensed from January 1 – December 31, 2016. A total of 2400 prescriptions (600 from each hospital) were assessed. A combination of prescription completeness and prescribing indicator forms were used to collect the data. Result From a total of 2400 prescriptions reviewed, only HFSUH and FHPH were using standard prescription at prevalence of 92.5 and 99.8%, respectively. Name and weight of the patient were the most and the least commonly recorded information, respectively. A total of 5217 drugs were prescribed with an average number of drugs per encounter to be 2.17 (±0.39) and the highest value (2.60) was observed at FHPH. The frequency of administration was the most commonly written component (85.0%) with an average of 1.85 per prescription. Among all prescriptions analyzed, the percentage of encounters with antimicrobials and injectables prescribed were 66.9 and 26.5%, respectively. The prevalence of drugs prescribed with generic name and from essential drug list were 4644 (89.01%) and 4613 (88.42%), respectively. Among health professional related information, dispenser name was the least documented in all hospitals with the prevalence being 3.9%. Conclusion JH and SECIIIH were not using standard prescriptions at all during the review period. Besides, some important components of the prescription such as age, sex and diagnosis were not properly recorded or missed at all in the selected hospitals. The tendency of prescribing drugs with dose and dosage form was very poor. Overall, none of the core prescribing indicators was in line with the WHO standards. These and other related problems should be investigated in-depth to find out the underlying problems for which interventional strategies can be designed to reverse this worrying practice.
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Affiliation(s)
- Tigist Gashaw
- 1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Mekonnen Sisay
- 1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Getnet Mengistu
- 2Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Firehiwot Amare
- 3Department of Pharmacy Practice, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Sarwar MR, Saqib A, Iftikhar S, Sadiq T. Antimicrobial use by WHO methodology at primary health care centers: a cross sectional study in Punjab, Pakistan. BMC Infect Dis 2018; 18:492. [PMID: 30268106 PMCID: PMC6162939 DOI: 10.1186/s12879-018-3407-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 09/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the antimicrobial (AM) use and prescribing patterns at primary health care centers (PHCCs) in Punjab, Pakistan. METHODS A cross-sectional study was designed according to the World Health Organization (WHO) methodology for AM usage from January, 2017 to June, 2017. Standard data collection forms designed by the WHO were used to collect the data from 32 PHCCs (16 rural healthcare centers (RHCs) and 16 basic health units (BHUs)) in Punjab province of Pakistan. PHCCs were randomly selected from 8 main cities. The study sample consisted of prescription records of 6400 outpatients (200 prescriptions records from each PHCC) and 800 inpatients (25 inpatient records from each PHCC). Data of the year 2016 were collected retrospectively by using systematic random sampling technique and analyzed through SPSS. RESULTS Among the hospital indicators, standard treatment guidelines (STGs) regarding the infectious diseases were not available in PHCCs. Number of days during which key AMs were out of stock was 12.1 days per month (range = 3.1-19.2). Out of total PHCC medicines costs, expenditures on AMs were 26.2% (range = 17.1-39.0). In case of prescribing indicators, the average number of AMs per prescription was 1.4 (range = 1.1-1.7), percentage of prescriptions prescribed with AMs was 81.5% (range = 68.9-89.1) and duration of AM treatment on average was 5.1 days per patient (range = 3.3-6.4). Average cost of prescribed AMs per patient was 1.3 USD (range = 0.6-4.3). The PHCCs prescribed a median of 5 (range = 3-9) types of AMs, including 10 (range = 5-15) individual agents. Out of 79.3% prescriptions of outpatients prescribed with AMs, only 16.4% were properly prescribed. Out of 100% prescriptions of inpatients prescribed with AMs, 12.1% were properly prescribed. Out of all the AM prescriptions 23.6% contained penicillins, 20.1% contained cephalosporins and 19.4% contained fluoroquinolones Metronidazole (18.0%), ciprofloxacin (16.5%) and co-amoxiclav (14.3%) were most commonly prescribed AMs. CONCLUSIONS In PHCCs, AMs were prescribed more frequently. However large proportions of these prescriptions were inappropriate. Continuous education and training of medical staff and cost effective policies could play an important role in promotion of rational use of AMs.
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Affiliation(s)
- Muhammad Rehan Sarwar
- Department of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan
- Akhtar Saeed College of Pharmaceutical Sciences, Lahore, Pakistan
| | - Anum Saqib
- Department of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan
| | - Sadia Iftikhar
- Akhtar Saeed College of Pharmaceutical Sciences, Lahore, Pakistan
| | - Tayyaba Sadiq
- Department of Pharmacy, University of Sargodha, Punjab, Pakistan
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Holloway KA, Kotwani A, Batmanabane G, Santoso B, Ratanawijitrasin S, Henry D. Promoting quality use of medicines in South-East Asia: reports from country situational analyses. BMC Health Serv Res 2018; 18:526. [PMID: 29976180 PMCID: PMC6034320 DOI: 10.1186/s12913-018-3333-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. The aim was to determine whether public-sector QUM is better in SEAR countries implementing essential medicines (EM) policies than in those not implementing them. METHODS Data on six QUM indicators and 25 EM policies were extracted from situational analysis reports of 20 country (2-week) visits made during 2010-2015. The average difference (as percent) for the QUM indicators between countries implementing versus not implementing specific policies was calculated. Policies associated with better (> 1%) QUM were included in regression of a composite QUM score versus total number of policies implemented. RESULTS Twenty-two policies were associated with better (> 1%) QUM. Twelve policies were associated with 3.6-9.5% significantly better use (p < 0.05), namely: standard treatment guidelines; formulary; a government unit to promote QUM; continuing health worker education on prescribing by government; limiting over-the-counter (OTC) availability of systemic antibiotics; disallowing public-sector prescriber revenue from medicines sales; not charging fees at the point of care; monitoring advertisements of OTC medicines; public education on QUM; and a good drug supply system. There was significant correlation between the number of policies implemented out of 22 and the composite QUM score (r = 0.71, r2 = 0.50, p < 0.05). CONCLUSIONS Country situational analyses allowed rapid data collection that showed EM policies are associated with better QUM. SEAR countries should implement all such policies.
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Affiliation(s)
- Kathleen Anne Holloway
- International Institute of Health Management Research, Jaipur, India. .,Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK.
| | - Anita Kotwani
- Department of Pharmacology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | | | - Budiono Santoso
- Independent Consultant in Medicines Policy, Yogyakarta, Indonesia
| | | | - David Henry
- Bond University, Gold Coast, QLD, Australia.,University of Toronto, Toronto, Canada
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Mahmić-Kaknjo M, Jeličić-Kadić A, Utrobičić A, Chan K, Bero L, Marušić A. Essential medicines availability is still suboptimal in many countries: a scoping review. J Clin Epidemiol 2018; 98:41-52. [PMID: 29452222 DOI: 10.1016/j.jclinepi.2018.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To identify uses of WHO Model list of essential medicines (EMs) and summarize studies examining EM and national EM lists (NEMLs). STUDY DESIGN AND SETTING In this scoping review, we searched PubMed, Scopus, WHO website and WHO Regional Databases for studies on NEMLs, reimbursement medicines lists, and WHO EML, with no date or language restrictions. RESULTS Three thousand one hundred forty-four retrieved documents were independently screened by two reviewers; 100 full-text documents were analyzed; 37 contained data suitable for quantitative and qualitative analysis on EMs availability (11 documents), medicines for specific diseases (13 documents), and comparison of WHO EML and NEMLs (13 documents). From the latter, two documents analyzed the relevance of evidence from Cochrane systematic reviews for medicines that were on NEMLs but not on the WHO EML. EMs availability is still suboptimal in low-income countries. Availability of children formulations and EMs for specific diseases such as chronic, cancer, pain, and reproductive health is suboptimal even in middle-income countries. CONCLUSION WHO EML can be used as a basic set of medicines for different settings. More evidence is needed into how NEMLs can contribute to better availability of children formulations, pain, and cancer medicines in developing countries.
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Affiliation(s)
- Mersiha Mahmić-Kaknjo
- Department of Clinical Pharmacology, Zenica Cantonal Hospital, Crkvice 67, 72000 Zenica, Bosnia and Herzegovina; Faculty of Medicine, University of Zenica, Fakultetska 3, 72000 Zenica, Bosnia and Herzegovina
| | - Antonia Jeličić-Kadić
- Department of Pediatrics, University of Hospital Split, Spinčićeva 1, 21000 Split, Croatia
| | - Ana Utrobičić
- Central Medical Library, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia; Cochrane Croatia, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - Kit Chan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, EH8 9 AG Edinburgh, Scotland, UK
| | - Lisa Bero
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Ana Marušić
- Cochrane Croatia, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia; Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia.
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Atif M, Scahill S, Azeem M, Sarwar MR, Babar ZUD. Drug utilization patterns in the global context: A systematic review. Health Policy and Technology 2017. [DOI: 10.1016/j.hlpt.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zellweger RM, Carrique-Mas J, Limmathurotsakul D, Day NPJ, Thwaites GE, Baker S. A current perspective on antimicrobial resistance in Southeast Asia. J Antimicrob Chemother 2017; 72:2963-2972. [PMID: 28961709 PMCID: PMC5890732 DOI: 10.1093/jac/dkx260] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Southeast Asia, a vibrant region that has recently undergone unprecedented economic development, is regarded as a global hotspot for the emergence and spread of antimicrobial resistance (AMR). Understanding AMR in Southeast Asia is crucial for assessing how to control AMR on an international scale. Here we (i) describe the current AMR situation in Southeast Asia, (ii) explore the mechanisms that make Southeast Asia a focal region for the emergence of AMR, and (iii) propose ways in which Southeast Asia could contribute to a global solution.
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Affiliation(s)
- Raphaël M Zellweger
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Juan Carrique-Mas
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P. J Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Guy E Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, UK
- The London School of Hygiene and Tropical Medicine, London, UK
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Holloway KA, Kotwani A, Batmanabane G, Puri M, Tisocki K. Antibiotic use in South East Asia and policies to promote appropriate use: reports from country situational analyses. BMJ 2017; 358:j2291. [PMID: 28874360 PMCID: PMC5598252 DOI: 10.1136/bmj.j2291] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Kathleen Holloway and colleagues discuss findings from a rapid assessment of antibiotic use and policies undertaken by South East Asian countries to drive further actions to reduce inappropriate use
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Affiliation(s)
- Kathleen Anne Holloway
- International Institute of Health Management Research, Jaipur, India
- Institute of Development Studies, University of Sussex, Brighton UK
- Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Anita Kotwani
- Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | | | - Monika Puri
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Klara Tisocki
- WHO Regional Office for South-East Asia, New Delhi, India
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Moye-Holz D, van Dijk JP, Reijneveld SA, Hogerzeil HV. Policy approaches to improve availability and affordability of medicines in Mexico - an example of a middle income country. Global Health 2017; 13:53. [PMID: 28764738 PMCID: PMC5540413 DOI: 10.1186/s12992-017-0281-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization recommends establishing and implementing a national pharmaceutical policy (NPP) to guarantee effective and equitable access to medicines. Mexico has implemented several policy approaches to regulate the pharmaceutical sector, but it has no formal NPP. This article describes the approach that the Mexican government has taken to improve availability and affordability of essential medicines. METHODS Descriptive policy analysis of public pharmaceutical policy proposals and health action plans on the basis of publicly available data and health progress reports, with a focus on availability and affordability of medicines. RESULTS The government has implemented pooled procurement, price negotiations, and an information platform in the public sector to improve affordability and availability. The government mainly reports on the savings that these strategies have generated in the public expenditure but their full impact on availability and affordability has not been assessed. CONCLUSIONS To increase availability and affordability of medicines in the public sector, the Mexican government has resorted on isolated strategies. In addition to efficient procurement, price negotiations and price information, other policy components and pricing interventions are needed. All these strategies should be included in a comprehensive NPP.
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Affiliation(s)
- Daniela Moye-Holz
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Jitse P van Dijk
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Hans V Hogerzeil
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
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Haque M. Essential Medicine Utilization and Situation in Selected Ten Developing Countries: A Compendious Audit. J Int Soc Prev Community Dent 2017; 7:147-160. [PMID: 28852629 PMCID: PMC5558247 DOI: 10.4103/jispcd.jispcd_224_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 11/04/2022] Open
Abstract
Medicine improves the quality of life and increases mean age of human beings as it fights against diseases. Accessibility to medicines is the fundamental right of every person. The principle of the essential medicines (EMs) is that a limited number of availability of medicine will promote to a better supply chain and rational prescribing to the rural and remote health centers for any developing countries. Furthermore, it was also expected that this concept will also ensure better procurement policy at lower costs, more in amount, with easier storage. Thereby, EMs will safeguard and improve distribution and dispensing of medicine. Correspondingly, motivational and dedicated training program regarding drug information and adverse drug reactions will boost up access to medicine and health-care. In addition, the selection of medicine from EM is the first step in the direction of the rational use of medicine and progress and ensuring the quality of health care. Thereafter, selection needs to be followed by appropriate use. Everyone should receive the right medicine, in an adequate dose for an adequate duration, with appropriate information and follow-up treatment, and at an affordable cost. The acceptance and implementation of World Health Organization-promoted EM policies in deferent countries have improved quality use of medicine in terms of accessibility and affordability, predominantly in developing countries. The corporations and teamwork among various participants of health care are instantly obligatory to progress equitable access to medicines in low- and middle-income countries.
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, 57000 Kuala Lumpur, Malaysia
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Atif M, Azeem M, Saqib A, Scahill S. Investigation of antimicrobial use at a tertiary care hospital in Southern Punjab, Pakistan using WHO methodology. Antimicrob Resist Infect Control 2017; 6:41. [PMID: 28465825 PMCID: PMC5410053 DOI: 10.1186/s13756-017-0199-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/21/2017] [Indexed: 01/21/2023] Open
Abstract
Background Globally, between 20 to 50% of antimicrobial consumption is inappropriate, causing significant impact on the quality of care, cost of therapy and incidence of adverse drug reactions. The purpose of this study was to investigate the prescribing patterns and utilization of antimicrobials in ten selected wards at Bahawal Victoria Hospital (BVH), Bahawalpur, Punjab, Pakistan. Methods A descriptive cross-sectional study was designed using the World Health Organization (WHO) indicators for antimicrobial use. Standard data collection forms were used in ten wards and the Pharmacy Department at BVH. Antimicrobial utilization patterns in terms of frequency and percentage were also determined. Systematic random sampling techniques were used to collect data from 1,000 prescription records out of 21,115 prescriptions written for the six months January to June 2016. Results For the hospital indicators, a formulary list or essential medicines list (FL/EML) was available, but standard treatment guidelines (STGs) for infectious diseases was not. The average number of days that key antimicrobials were out of stock was 3.3 days per month. The expenditure on antimicrobials as a percentage of the total medicines costs was 12.2%. For the prescribing indicators, the percentage of hospitalizations with antimicrobial(s) prescribed was 82.3%, and the average number of antimicrobials per hospitalization was 1.4 (SD = 0.6). The average duration of antimicrobial treatment per hospitalization was 5.4 days (SD = 3.2). The average cost of antimicrobials prescribed per hospitalization was USD 5.4 (SD = 6.7). None of the patients who were prescribed antimicrobials, received AM according to the STGs (pneumonia and cesarean section cases). Among the patient-care and supplemental indicators, the average duration of hospital stay of patients who received antimicrobials was 6.4 (SD = 4.3) days. The drug sensitivity testing was almost non-existent, with only 0.24% prescription records having drug sensitivity tests. Ceftriaxone (39.6%), metronidazole (23.4%) and cefotaxime (23.1%) were the top most frequently prescribed antimicrobials. Conclusions The results of the current study revealed less than optimal antimicrobial prescribing and utilization patterns of selected wards at BVH. Continuous education and training of physicians, and cost-effective policies could play an important role in promoting the rational use of antimicrobials in this setting. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0199-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Azeem
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Anum Saqib
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Shane Scahill
- School of Management, Massey University, Auckland, New Zealand
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Atif M, Sarwar MR, Azeem M, Naz M, Amir S, Nazir K. Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan. BMC Health Serv Res 2016; 16:684. [PMID: 27931213 PMCID: PMC5146889 DOI: 10.1186/s12913-016-1932-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/03/2016] [Indexed: 12/15/2022] Open
Abstract
Background Proper utilization of medicines is a critical component of pharmaceutical care plan. The aim of this study was to assess drug use pattern at ten primary healthcare centers (PHCCs) of the Bahawalpur district of the Punjab province of Pakistan by employing the WHO/INRUD core drug use indicators. Methods This was a descriptive, non-experimental and cross-sectional study. For the prescribing indicators, 1000 prescriptions (100 prescriptions per PHCC) were systematically sampled out of the total 290,000 prescriptions written during January to December 2014. A total of 300 randomly selected patients (30 per PHCC) and 10 pharmacy personnel (one per PHCC) were observed and interviewed to investigate the patient-care and facility-specific indicators, respectively. We used published ideal standards for each of the WHO/INRUD indicators. Results Among the prescribing indicators, the average number of drugs per encounter was 3.4 (SD = 0.8) (optimal range = 1.6–1.8), the drugs prescribed by the generic name were 71.6% (optimal value = 100%), the encounters with an antibiotic prescribed were 48.9% (optimal range = 20.0–26.8%), the encounters with an injection prescribed were 27.1% (optimal range = 13.4–24.1%) and the drugs prescribed from the Essential Drugs List (EDL) were 93.4% (optimal value = 100%). Among the patient-care indicators, the average consultation time was 2.2 min (SD = 0.8) (optimal value ≥10 min), the average dispensing time was 38 s (SD = 12.1) (optimal value ≥90 s), the percentage of drugs actually dispensed was 90.9% (optimal value = 100%), the percentage of drugs adequately labeled was 100% (optimal value = 100%) and the patients’ knowledge of correct dosage was 62.1% (optimal value = 100%). Among the facility-specific indicators, all PHCCs had a copy of the EDL and the key drugs available in the stock were 82% (optimal value = 100%). Conclusions Irrational use of drugs was observed in all healthcare facilities. This study necessitates the need to implement the WHO/INRUD recommended 12 core interventions to promote rational use of medicines.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | | | - Muhammad Azeem
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mubeen Naz
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Salma Amir
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Kashaf Nazir
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Atif M, Azeem M, Sarwar MR, Shahid S, Javaid S, Ikram H, Baig U, Scahill S. WHO/INRUD prescribing indicators and prescribing trends of antibiotics in the Accident and Emergency Department of Bahawal Victoria Hospital, Pakistan. Springerplus 2016; 5:1928. [PMID: 27933228 PMCID: PMC5099312 DOI: 10.1186/s40064-016-3615-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 10/28/2016] [Indexed: 11/10/2022]
Abstract
A descriptive, retrospective and cross sectional study was conducted to assess the prescribing practices and antibiotic use patterns in the Accident and Emergency department of the Bahawal Victoria Hospital, Bahawalpur, Pakistan. A sample of 4320 prescriptions (systematic random sampling) was drawn out of a total of 1,080,000 prescriptions written during the period 1st January-31st December 2014. The standard World Health Organization/International Network for Rational Use of Drugs prescribing indicators were used to determine the prescribing practices of physicians. Published ideal standards for each of the indicators were used to identify irrational drug use. We also utilized an additional indicator to report the percentage share of antibiotics prescribed. The average number of drugs prescribed per encounter was 2.3 (SD = 1.3) (optimal value 1.6-1.8). Drugs prescribed by generic name occurred 83.1% of the time (optimal value 100%). Antibiotics and injections were prescribed 52.4% (optimal value 20.0-26.8%) and 98.0% (optimal value 13.4-24.1%) of the time respectively. Drugs prescribed from the Essential Drugs List equated to 81.5% (optimal value 100%). Out of 52.4% (n = 2262) prescriptions with antibiotics prescribed, 77.7% (n = 1758) had one antibiotic, 22.1% (n = 499) included two antibiotics, and 0.2% (n = 5) had three antibiotics. Cephalosporins were the most commonly prescribed class of antibiotics (81.5%) followed by penicillins (6.4%) and fluoroquinolones (6.2%). Among the individual antibiotics, ceftriaxone contributed the highest percentage share at 71.8% followed by cefotaxime (5.6%) and metronidazole (4.7%). The most frequently prescribed antibiotic combination was ciprofloxacin with metronidazole (52.1%). Irrational prescribing practices were common. Continuous education and training of physicians is required to ensure rational prescribing at Bahawal Victoria Hospital in the future.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Muhammad Azeem
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Muhammad Rehan Sarwar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Samia Shahid
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Sidra Javaid
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Huria Ikram
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Uzma Baig
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Shane Scahill
- School of Management, Massey University, Auckland, New Zealand
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Affiliation(s)
- Gina Eom
- School of Medicine (Eom), Queen's University, Kingston; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Hannah Chair, History of Medicine (Duffin), Queen's University, Kingston, Ont
| | - Paul Grootendorst
- School of Medicine (Eom), Queen's University, Kingston; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Hannah Chair, History of Medicine (Duffin), Queen's University, Kingston, Ont
| | - Jacalyn Duffin
- School of Medicine (Eom), Queen's University, Kingston; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Hannah Chair, History of Medicine (Duffin), Queen's University, Kingston, Ont.
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Nsabagasani X, Ogwal-Okeng J, Hansen EH, Mbonye A, Muyinda H, Ssengooba F. 'Better medicines for children' within the Integrated Management of Childhood Illness framework: a qualitative inquiry in Uganda. J Pharm Policy Pract 2016; 9:22. [PMID: 27280024 PMCID: PMC4897804 DOI: 10.1186/s40545-016-0071-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/27/2016] [Indexed: 11/28/2022] Open
Abstract
Background The Integrated Management of Childhood Illnesses is the main approach for treating children in more than 100 low income countries worldwide. In 2007, the World Health Assembly urged countries to integrate ‘better medicines for children’ into their essential medicines lists and treatment guidelines. WHO regularly provides generic algorithms for IMCI and publishes the Model Essential Medicines List with child-friendly medicines based on new evidence for member countries to adopt. However, the status of ‘better medicines for children’ within the Integrated Management of Childhood Illnesses approach in Uganda has not been studied. Methods Qualitative interviews were conducted with: two officials from the ministry of health; two district health officials and, 22 health workers from public health facilities. Interview transcripts were manually analyzed for manifest and latent content. Results Child-appropriate dosage formulations were not included in the package for the Integrated Management of Childhood Illnesses and ministry officials attributed this to resource constraints and lack of initial guidance from the World Health Organization. Underfunding reportedly undercut efforts to: orient health workers; do support supervision and update treatment guidelines to reflect ‘better medicines for children’. Health workers reported difficulties in administering tablets and capsules to under-five children and that’s why they preferred liquid oral dosage formulations, suppositories and injections. Conclusions The IMCI strategy in Uganda was not revised to reflect child-appropriate dosage formulations – a missed opportunity for improving the quality of management of childhood illnesses. Funding was an obstacle to the integration of child-appropriate dosage formulations. Ministry of health should prioritize funding for the Integrated Management of Childhood Illnesses and revising the Essential Medicines and Health Supplies List of Uganda, the Uganda Clinical Guidelines and, the Treatment Charts for the Integrated Management of Childhood Illnesses to reflect child-appropriate dosage formulations.
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Affiliation(s)
- Xavier Nsabagasani
- Child Health and Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Japer Ogwal-Okeng
- Department of Pharmacology and Therapeutics, Gulu University, Gulu, Uganda
| | - Ebba Holme Hansen
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anthony Mbonye
- Department of Community Health, Ministry of Health Uganda, Kampala, Uganda ; Department of Health, Uganda Christian University, Mukono, Uganda
| | - Herbert Muyinda
- Child Health and Development Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Freddie Ssengooba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Abstract
BACKGROUND Inappropriate overuse of antibiotics contributes to antimicrobial resistance (AMR), yet policy implementation to reduce inappropriate antibiotic use is poor in low and middle-income countries. AIMS To determine whether public sector inappropriate antibiotic use is lower in countries reporting implementation of selected essential medicines policies. MATERIALS AND METHODS Results from independently conducted antibiotic use surveys in countries that did, and did not report implementation of policies to reduce inappropriate antibiotic prescribing, were compared. Survey data on four validated indicators of inappropriate antibiotic use and 16 self-reported policy implementation variables from WHO databases were extracted. The average difference for indicators between countries reporting versus not reporting implementation of specific policies was calculated. For 16 selected policies we regressed the four antibiotic use variables on the numbers of policies the countries reported implementing. RESULTS Data were available for 55 countries. Of 16 policies studied, four (having a national Ministry of Health unit on promoting rational use of medicines, a national drug information centre and provincial and hospital drugs and therapeutics committees) were associated with statistically significant reductions in antibiotic use of ≥20% in upper respiratory infection (URTI). A national strategy to contain antibiotic resistance was associated with a 30% reduction in use of antibiotics in acute diarrheal illness. Policies seemed to be associated with greater effects in antibiotic use for URTI and diarrhea compared with antibiotic use in all patients. There were negative correlations between the numbers of policies reported implemented and the percentage of acute diarrhoea cases treated with antibiotics (r = -0.484, p = 0.007) and the percentage of URTI cases treated with antibiotics (r = -0.472, p = 0.005). Major study limitations were the reliance on self-reported policy implementation data and antibiotic use data from linited surveys. CONCLUSIONS Selected essential medicines policies were associated with lower antibiotic use in low and middle income countries.
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Affiliation(s)
- Kathleen Anne Holloway
- Department of Health Systems Development, World Health Organization, Regional Office SouthEast Asia, New Delhi, India
- * E-mail:
| | - Laura Rosella
- Epidemiology Division, Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - David Henry
- Epidemiology Division, Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
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Kamerman PR, Wadley AL, Davis KD, Hietaharju A, Jain P, Kopf A, Meyer AC, Raja SN, Rice ASC, Smith BH, Treede RD, Wiffen PJ. World Health Organization essential medicines lists: where are the drugs to treat neuropathic pain? Pain 2015; 156:793-7. [PMID: 25894010 DOI: 10.1097/01.j.pain.0000460356.94374.a1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duong M, Moles RJ, Chaar B, Chen TF; World Hospital Pharmacy Research Consortium (WHoPReC). Essential Medicines in a High Income Country: Essential to Whom? PLoS One 2015; 10:e0143654. [PMID: 26650544 DOI: 10.1371/journal.pone.0143654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/07/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To explore the perspectives of a diverse group of stakeholders engaged in medicines decision making around what constitutes an “essential” medicine, and how the Essential Medicines List (EML) concept functions in a high income country context. Methods In-depth qualitative semi-structured interviews were conducted with 32 Australian stakeholders, recognised as decision makers, leaders or advisors in the area of medicines reimbursement or supply chain management. Participants were recruited from government, pharmaceutical industry, pharmaceutical wholesale/distribution companies, medicines non-profit organisations, academic health disciplines, hospitals, and consumer groups. Perspectives on the definition and application of the EML concept in a high income country context were thematically analysed using grounded theory approach. Findings Stakeholders found it challenging to describe the EML concept in the Australian context because many perceived it was generally used in resource scarce settings. Stakeholders were unable to distinguish whether nationally reimbursed medicines were essential medicines in Australia. Despite frequent generic drug shortages and high prices paid by consumers, many struggled to describe how the EML concept applied to Australia. Instead, broad inclusion of consumer needs, such as rare and high cost medicines, and consumer involvement in the decision making process, has led to expansive lists of nationally subsidised medicines. Therefore, improved communication and coordination is needed around shared interests between stakeholders regarding how medicines are prioritised and guaranteed in the supply chain. Conclusions This study showed that decision-making in Australia around reimbursement of medicines has strayed from the fundamental utilitarian concept of essential medicines. Many stakeholders involved in medicine reimbursement decisions and management of the supply chain did not consider the EML concept in their approach. The wide range of views of what stakeholders considered were essential medicines, challenges whether the EML concept is out-dated or underutilised in high income countries.
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Bovet P, Chiolero A, Paccaud F, Banatvala N. Screening for cardiovascular disease risk and subsequent management in low and middle income countries: challenges and opportunities. Public Health Rev 2015; 36:13. [PMID: 29450041 PMCID: PMC5804497 DOI: 10.1186/s40985-015-0013-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 11/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background Cardiovascular disease (CVD), mainly heart attack and stroke, is the leading cause of premature mortality in low and middle income countries (LMICs). Identifying and managing individuals at high risk of CVD is an important strategy to prevent and control CVD, in addition to multisectoral population-based interventions to reduce CVD risk factors in the entire population. Methods We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs. Results A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability of affordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). This also emphasises the need to re-orient health systems in LMICs towards chronic diseases management. Conclusion The large burden of CVD in LMICs and the fact that persons with high CVD can be identified and managed along cost-effective interventions mean that health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
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Affiliation(s)
- Pascal Bovet
- 1Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Rue de la Corniche 10, 2013 Lausanne, Switzerland
| | - Arnaud Chiolero
- 1Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Rue de la Corniche 10, 2013 Lausanne, Switzerland
| | - Fred Paccaud
- 1Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Rue de la Corniche 10, 2013 Lausanne, Switzerland
| | - Nick Banatvala
- 2Noncommunicable Diseases and Mental Health Cluster, World Health Organization, Geneva, Switzerland
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Massele A, Godman B, Adorka M, Fadare J, Gray A, Lubbe M, Ogunleye O, Truter I. Initiative to progress research on medicine utilization in Africa: formation of the Medicines Utilization Research in Africa group. Expert Rev Pharmacoecon Outcomes Res 2015; 15:607-10. [DOI: 10.1586/14737167.2015.1065735] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Olivera MJ, Fory JA, Olivera AJ. Quality assessment of clinical practice guidelinesfor Chagas disease. Rev Soc Bras Med Trop 2015; 48:343-6. [DOI: 10.1590/0037-8682-0251-2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/12/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mario Javier Olivera
- Instituto Nacional de Salud, Colombia; Universidad Nacional de Colombia, Colombia
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Chalmers L, Cross J, Chu CS, Phyo AP, Trip M, Ling C, Carrara V, Watthanaworawit W, Keereecharoen L, Hanboonkunupakarn B, Nosten F, McGready R. The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border. Trop Med Int Health 2015; 20:1281-9. [PMID: 25963224 PMCID: PMC4758398 DOI: 10.1111/tmi.12541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective Published literature from resource‐limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point‐of‐care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. Methods One‐year retrospective analysis in three clinics on the Thailand–Myanmar border of non‐pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >105 CFU/ml. Results In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended‐spectrum β‐lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells <5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. Conclusion One rapid, cost‐effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy.
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Affiliation(s)
- Lauren Chalmers
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jessica Cross
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Cindy S Chu
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Margreet Trip
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Clare Ling
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Verena Carrara
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Wanitda Watthanaworawit
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lily Keereecharoen
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Nsabagasani X, Ogwal-Okeng J, Mbonye A, Ssengooba F, Muhumuza S, Hansen EH. Availability and utilization of the WHO recommended priority lifesaving medicines for under five-year old children in public health facilities in Uganda: a cross-sectional survey. J Pharm Policy Pract 2015; 8:18. [PMID: 25995847 PMCID: PMC4438460 DOI: 10.1186/s40545-015-0038-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/28/2015] [Indexed: 12/16/2022] Open
Abstract
Objectives To explore the availability and utilization of the World Health Organization (WHO) recommended priority life-saving medicines for children under five in public health facilities in Uganda. Methods We conducted a cross sectional survey in 32 lower level public facilities in Jinja district of Uganda. A proportionate number of facilities were randomly selected in each stratum following a hierarchy of Health Centers (HC) defined according to the level of care they provide: 17 HC IIs, 10 HC IIIs and 5 HC IVs. In the facilities, we verified the availability of the WHO recommended priority medicines for diarrhea, sepsis, pneumonia and malaria. 81 health workers from the facilities reported what they prescribed for children with the above diseases. Results Oral rehydration salt (ORS) and zinc sulphate dispersible tablets for diarrhea were available in all HC IIs and IIIs and in only 60% of HC IVs. Procaine benzyl penicillin injection powder for treatment of sepsis was available in the majority of all HCs with: 100% of HC of IVs, 83% of HC IIIs and 82% of HC IIs. Medicines for pneumonia were limited across all the HCs with: Amoxicillin dispersible tablets in only 30% of the HC IIs and 40% of the HC IVs. The most uncommon were child-friendly priority medicines for malaria with: Artesunate injection in only 6% of HC IIs, 14% of HC IIIs and 20% of HC IVs; Artemether lumefantrine dispersible tablets and rectal artesunate were missing in all the 32 HCs. Less than a third of the health workers reported prescribing zinc sulphate and ORS for diarrhea, 86% reported procaine benzyl penicillin injection powder for sepsis, and 57% reported amoxicillin dispersible tablets for pneumonia. None reported prescribing Artemether lumefantrine dispersible tablets and rectal artesunate for malaria. Conclusions There is low availability and utilization of life-saving priority medicines for pneumonia and malaria in public health facilities in Uganda. However, the priority medicines for diarrhea and sepsis are available and highly prescribed by the health workers.
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Affiliation(s)
- Xavier Nsabagasani
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Jasper Ogwal-Okeng
- Department of Pharmacology and Therapeutics, Gulu University, Gulu Municipality, Uganda
| | - Anthony Mbonye
- Ministry of Health Uganda and Department of Health, Uganda Christian University, Kampala, Uganda
| | - Freddie Ssengooba
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Simon Muhumuza
- Child Health and Development Center, College of Health Sciences, Makerere University, P.O. Box 6717, Kampala, Uganda
| | - Ebba Holme Hansen
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
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