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Mudenda S, Chilimboyi R, Matafwali SK, Daka V, Mfune RL, Kemgne LAM, Bumbangi FN, Hangoma J, Chabalenge B, Mweetwa L, Godman B. Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications. JAC Antimicrob Resist 2024; 6:dlae023. [PMID: 38389802 PMCID: PMC10883698 DOI: 10.1093/jacamr/dlae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. Methods A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Results Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. Conclusions There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Robert Chilimboyi
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
- Department of Pharmacy, Saint Francis' Hospital, Private Bag 11, Katete, Zambia
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | - Ruth Lindizyani Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | | | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, P.O. Box 30226, Lusaka, Zambia
| | - Jimmy Hangoma
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, P.O. Box 31890, Lusaka, Zambia
| | - Larry Mweetwa
- Department of Science and Technology, Ministry of Technology and Science, Maxwell House, Los Angeles Boulevard, P. O. Box 50464, Lusaka, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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Abdullah S, Saleem Z, Godman B. Coping with increasing medicine costs through greater adoption of generic prescribing and dispensing in Pakistan as an exemplar country. Expert Rev Pharmacoecon Outcomes Res 2024; 24:167-170. [PMID: 37936327 DOI: 10.1080/14737167.2023.2280802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Saad Abdullah
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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Massele A, Rogers AM, Gabriel D, Mayanda A, Magoma S, Cook A, Chigome A, Lorenzetti G, Meyer JC, Moore CE, Godman B, Minzi O. A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications. Medicina (Kaunas) 2023; 59:2195. [PMID: 38138298 PMCID: PMC10745081 DOI: 10.3390/medicina59122195] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Background and objectives: There are concerns with the current prescribing practices of antibiotics in ambulatory care in Tanzania, including both the public and private sectors. These concerns need to be addressed as part of the national action plan (NAP) of Tanzania to reduce rising antimicrobial resistance (AMR) rates. Issues and concerns include high rates of prescribing of antibiotics for essentially self-limiting conditions. Consequently, there is a need to address this. As a result, the aims of this narrative review were to comprehensively summarize antibiotic utilization patterns particularly in ambulatory care and their rationale in Tanzania and to suggest ways forward to improve future prescribing practices. Materials and Methods: We undertook a narrative review of recently published studies and subsequently documented potential activities to improve future prescribing practices. Potential activities included instigating quality indicators and antimicrobial stewardship programs (ASPs). Results: Published studies have shown that antibiotics are being excessively prescribed in ambulatory care in Tanzania, in up to 95% to 96.3% of presenting cases depending on the sector. This is despite concerns with their appropriateness. High rates of antibiotic prescribing are not helped by variable adherence to current treatment guidelines. There have also been concerns with extensive prescribing of 'Watch' antibiotics in the private sector. Overall, the majority of antibiotics prescribed across the sectors, albeit inappropriately, were typically from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. The inappropriate prescribing of antibiotics in ambulatory care is linked to current knowledge regarding antibiotics, AMR, and ASPs among both prescribers and patients. Recommended activities for the future include improved education for all groups, the instigation of updated quality indicators, and the regular monitoring of prescribing practices against agreed-upon guidelines and indicators. Education for healthcare professionals on ASPs should start at undergraduate level and continue post qualification. Community advocacy on the rational use of antibiotics should also include social media activities to dispel misinformation. Conclusion: The quality of current prescribing practices of antibiotics in ambulatory care is sub-optimal in Tanzania. This needs to be urgently addressed.
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Affiliation(s)
- Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
| | - Anastasia Martin Rogers
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Deogratias Gabriel
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Ashura Mayanda
- Department of Microbiology and Parasitology, Faculty of Medicine, Hubert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania; (A.M.R.); (D.G.); (A.M.)
| | - Sarah Magoma
- Department of Infectious Diseases, Faculty of Medicine, University of Dodoma, Dodoma P.O. Box 582, Tanzania;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar Es Salaam P.O. Box 65013, Tanzania;
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Chigome A, Ramdas N, Skosana P, Cook A, Schellack N, Campbell S, Lorenzetti G, Saleem Z, Godman B, Meyer JC. A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:1540. [PMID: 37887241 PMCID: PMC10604704 DOI: 10.3390/antibiotics12101540] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.
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Affiliation(s)
- Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa;
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
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Haseeb A, Saleem Z, Faidah HS, Saati AA, AlQarni A, Iqbal MS, Alghamdi S, Elrggal ME, AlGethamy M, Radwan RM, Mahrous AJ, Abuhussain SSA, Khayyat SM, Ibrahim K, Godman B, Sheikh A. Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic. Antibiotics (Basel) 2023; 12:1299. [PMID: 37627718 PMCID: PMC10451798 DOI: 10.3390/antibiotics12081299] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Hani Saleh Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdullah A. Saati
- Department of Community Medicine & Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdullmoin AlQarni
- Department of Infectious Diseases, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 57911, Saudi Arabia
| | - Mahmoud E. Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Manal AlGethamy
- Department of Infection Prevention & Control Program, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia
| | - Rozan Mohammad Radwan
- Pharmaceutical Care Department, Alnoor Specialist Hospital, Makkah 24382, Saudi Arabia
| | - Ahmad Jamal Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | | | - Sarah M. Khayyat
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Kiran Ibrahim
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG7 2QL, UK
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh EH16 4UX, UK
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Sono TM, Yeika E, Cook A, Kalungia A, Opanga SA, Acolatse JEE, Sefah IA, Jelić AG, Campbell S, Lorenzetti G, Ul Mustafa Z, Marković-Peković V, Kurdi A, Anand Paramadhas BD, Rwegerera GM, Amu AA, Alabi ME, Wesangula E, Oluka M, Khuluza F, Chikowe I, Fadare JO, Ogunleye OO, Kibuule D, Hango E, Schellack N, Ramdas N, Massele A, Mudenda S, Hoxha I, Moore CE, Godman B, Meyer JC. Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Rev Anti Infect Ther 2023; 21:1025-1055. [PMID: 37740561 DOI: 10.1080/14787210.2023.2259106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.
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Affiliation(s)
- Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Eugene Yeika
- Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Bene D Anand Paramadhas
- Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- DestinyMedical and Research Solutions Proprietary Limited, Gaborone, Botswana
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
| | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Margaret Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
| | - Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, School of Veterinary Meicine, University of Zambia, Lusaka, Zambia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho HealthSciences University, Garankuwa, Pretoria, South Africa
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Zin CS, Ab Rahman NS, Mohamed Nazar NI, Kurdi A, Godman B. Trends in the Cost of Medicines, Consultation Fees and Clinic Visits in Malaysia's Private Primary Healthcare System: Employer Health Insurance Coverage. J Multidiscip Healthc 2023; 16:1683-1697. [PMID: 37350986 PMCID: PMC10284298 DOI: 10.2147/jmdh.s403589] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
Objective To examine trends in the cost of medicines, consultation fees and clinic visits among the employees covered by the employer health insurance in Malaysia's private primary healthcare system in Malaysia. Designs Retrospective cross-sectional study. Setting PMCare claims database from January 2016 to August 2019. Participants A total of 83,556 outpatient clinic visits involving 10,150 IIUM employees of the International Islamic University Malaysia (IIUM) to private general practitioners (GPs). During the study period, IIUM adopts the incentive structure of capping coverage at Ringgit Malaysia (RM) 45/outpatient visit (USD 10.58) to cover for consultation fees and medicine costs. Main Outcome Measures The monthly percentage change in the number of clinic visits, medicine costs, consultation fees and total costs between January 2016 and August 2019. A simple linear regression using Stata v15.1 was also performed to measure the association between the characteristics of the prescribed medicines and medicine charges. Results The number of clinic visits per patient increased by 17% from January 2016 to August 2019, with consultation fees increasing by 113.9% and total costs by 7.9% per clinic visit per patient. Conversely, the cost of medicines and the number of medicines prescribed per clinic visit per patient decreased by 39.7% and 6.3%, respectively. Conclusion Within the incentive structure of capping the total amount of coverage per clinic visit, medicine costs were reduced by decreasing the number of medicines prescribed, to offset the increased consultation fees. This may create perverse incentives that affect medicine use with negative consequences for the health system and health insurers.
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Affiliation(s)
- Che Suraya Zin
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norny Syafinaz Ab Rahman
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nor Ilyani Mohamed Nazar
- Big Data Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region Government, Iraq
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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8
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Siachalinga L, Godman B, Mwita JC, Sefah IA, Ogunleye OO, Massele A, Lee IH. Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications. Infect Drug Resist 2023; 16:2179-2190. [PMID: 37077250 PMCID: PMC10108870 DOI: 10.2147/idr.s398223] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The rapid rise in antimicrobial resistance (AMR) globally, impacting on morbidity, mortality and costs with sub-Saharan African countries reporting the greatest burden is a concern. Instigation of antimicrobial stewardship programs (ASPs) can improve antibiotic use in hospitals and reduce AMR. Implementing ASPs requires knowledge of antibiotic utilization against agreed quality indicators with the data obtained from point prevalence surveys (PPS), hence the need to document antibiotic utilization patterns in sub-Saharan Africa. METHODS A narrative review to document current utilization patterns, challenges, indicators and ASPs across sub-Saharan Africa based on previous reviews by the authors, supplemented by the considerable knowledge and experience of the co-authors. RESULTS Results from multiple PPS studies showed a high prevalence of antibiotic use among hospitals, mostly over 50%. Prevalence rates ranged from as low as 37.7% in South Africa to as high as 80.1% in Nigeria. There was also considerable prescribing of broad-spectrum antibiotics which could be due to lack of facilities within hospitals, alongside concerns with co-payments to perform microbiological tests, resulting in empiric prescribing. This is a concern alongside lack of guidelines or adherence to guidelines, which was as low as 4% in one study. Another concern was the high rates of extended prophylaxis to prevent surgical site infections (SSIs), with antibiotics often prescribed for longer than 24 hours, usually multiple doses. Several quality indicators have been used to evaluate antibiotic utilization providing exemplars for the future. Among the initiatives being instigated to improve antibiotic use, ASPs have proved effective. For ASPs to be successful objectives and indicators must be agreed, and regular audits undertaken. CONCLUSION Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR.
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Affiliation(s)
- Linda Siachalinga
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, 346, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, 02084, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, 100271, Nigeria
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hubert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
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9
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Kwon HY, Godman B. Editorial: Pharmaceutical policy, impact and health outcomes. Front Pharmacol 2023; 14:1150055. [PMID: 36865922 PMCID: PMC9971951 DOI: 10.3389/fphar.2023.1150055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Republic of Korea
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates,*Correspondence: Brian Godman,
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10
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Mbonane H, Sibanda M, Godman B, Meyer JC, Matlala M. Knowledge, attitudes and practices of healthcare professionals on the use of an electronic stock visibility and management tool in a middle-income country: Implications for access to medicines. Explor Res Clin Soc Pharm 2023; 9:100233. [PMID: 36845673 PMCID: PMC9945761 DOI: 10.1016/j.rcsop.2023.100233] [Citation(s) in RCA: 1] [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: 07/08/2022] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Background The Stock Visibility System (SVS) is a mobile application and web-based management tool used at public primary health care (PHC) facilities in South Africa to capture and monitor medicines availability, providing visibility at national level. Medicine stock-outs are prevalent despite the implementation of SVS, compromising patient care. This study aimed to assess the knowledge, attitudes and practices (KAP) of healthcare professionals (HCPs) on the use of the SVS at PHC level to provide future guidance. Method A cross-sectional study using a structured self-administered questionnaire among 206 HCPs at 21 randomly selected PHC facilities located in a health district in KwaZulu-Natal Province, South Africa. Closed-ended questions were used to collect data on socio-demographic characteristics, knowledge on the SVS and practices on its use. A Likert scale was used to determine attitudes towards the SVS. Cronbach's alpha (α) was used to assess the internal consistency of the questionnaire and independent samples t-test and one-way analysis of variance (ANOVA) was used to test statistical difference in the mean scores for KAP and socio-demographic variables. Association between knowledge and practices, and attitude and practices was determined using odds ratios (OR) and Chi-square. Results The majority (99.5%) of HCPs had previous training on SVS. Nearly two thirds (62.1%; 128/206) generally had good knowledge about the SVS and 76.7% (158/206) had positive attitudes towards the SVS while only 17.0% had a good practice score. There was no statistically significant association between KAP of HCPs on the use of the SVS, and sociodemographic variables (HCP qualification, age and sex). There was a significant association between the knowledge and practice scores (aOR: 5.44; 95% CI: 1.92-15.4; p = 0.001). Although positive attitudes, was associated with good practices, it was not statistically significant (OR: 1.21; 95% CI: 0.46-3.22; p = 0.702). Conclusions HCPs in this district had poor practices when using SVS despite good knowledge and positive attitudes towards SVS and the higher the HCPs knowledge of SVS, the more desirable the practices on SVS. This underscores the need for continuous training of HCPs to ensure a constant and efficient supply of medicines to meet the health needs of the population.
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Affiliation(s)
- Hlalanathi Mbonane
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,East Boom Community Health Centre, 541 Boom Street, Pietermaritzburg 3201, South Africa
| | - Mncengeli Sibanda
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, Molotlegi Street, Ga-Rankuwa 0208, South Africa,Corresponding author at: Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa 0208, South Africa.
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa,South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Moliehi Matlala
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University; Molotlegi Street, Ga-Rankuwa 0208, South Africa
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11
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Xu Y, Zhu L. Pharmaceutical enterprises drug quality strategy Moran analysis considering government supervision and new media participation. Front Public Health 2023; 10:1079232. [PMID: 36733287 PMCID: PMC9887106 DOI: 10.3389/fpubh.2022.1079232] [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: 11/11/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
The improvement of drug quality requires not only the supervision of government, but also the participation of new media. Therefore, this paper considers the impact of government regulation and new media reports on pharmaceutical enterprises, constructs a Moran Process evolutionary game model, and analyzes the evolution trajectory of pharmaceutical enterprises' choice of drug quality improvement strategy and drug cost reduction strategy. We obtain the conditions for the two strategies to achieve evolutionary stability under the dominance of external factors and the dominance of expected returns. To verify the theoretical results, we conduct a numerical simulation by the software MATLAB 2021b. The results show that, first of all, when the government penalty is high, the drug quality improvement strategy tends to become an evolutionary stable solution, increasing the penalty amount will help promote the improvement of drug quality. What's more, when the government penalty is low and the new media influence is low, the drug cost reduction strategy is easier to dominate. The higher the new media influence, the higher the probability that pharmaceutical enterprises choose the drug quality improvement strategy. Thirdly, when the number of pharmaceutical enterprises is lower than a threshold, the drug quality improvement strategy is easier to dominate. Finally, the drug quality improvement strategy is dominant when the quality cost factor is low and the government penalty is high, the drug cost reduction strategy is dominant when the quality cost factor is high and the government penalty is low. Above all, this paper provides countermeasures and suggestions for the drug quality improvement of pharmaceutical enterprises in practice.
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Affiliation(s)
- Yanping Xu
- School of Business, Shandong Normal University, Ji'nan, China,Quality Research Center, Shandong Normal University, Ji'nan, China
| | - Lilong Zhu
- School of Business, Shandong Normal University, Ji'nan, China,Quality Research Center, Shandong Normal University, Ji'nan, China,*Correspondence: Lilong Zhu ✉ ; ✉
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12
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Meyer JC, MacBride-Stewart S, Fadare JO, Abdulrahman Jairoun A, Haque M, Massele A, Kumar S, Sefah IA, P Skosana P, Godman B. Key Considerations From a Health Authority Perspective When Proton Pump Inhibitors Are Used to Treat Gastroesophageal Reflux Disease (GERD) and Their Implications. Cureus 2022; 14:e31918. [DOI: 10.7759/cureus.31918] [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] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
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13
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Kalungia AC, Mukosha M, Mwila C, Banda D, Mwale M, Kagulura S, Ogunleye OO, Meyer JC, Godman B. Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future. Antibiotics (Basel) 2022; 11:1626. [PMID: 36421270 PMCID: PMC9687079 DOI: 10.3390/antibiotics11111626] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 10/21/2023] Open
Abstract
Introduction: There are increasing concerns with growing rates of antimicrobial resistance (AMR) across Africa, including in Zambia, enhanced by inappropriate utilization of antibiotics across the sectors. There is a need in hospitals to document current prescribing patterns via point prevalence surveys (PPS) alongside recognized indicators to improve future use. The findings can subsequently be used to develop and instigate appropriate antimicrobial stewardship programs (ASPs) to improve the quality of future antimicrobial prescribing across Zambia. This includes encouraging the prescribing of 'Access' over 'Watch' and 'Reserve' antibiotics where pertinent. Methods: A PPS was undertaken using the WHO methodology among 10 first- and second-level public hospitals across the 10 provinces of Zambia. A sampling process was used to select the hospitals. Results: The prevalence of antibiotic use among the in-patients was 307/520 (59.0%), with a high rate of empiric prescribing of ceftriaxone at 36.1% of all antibiotics prescribed (193/534). The reason for antibiotic use was recorded in only 15.7% of occasions and directed treatment prescribed in only 3.0% of occasions. Compliance with the national standard treatment guidelines (STGs) was also low at only 27.0% of occasions. Conclusion: High empiric prescribing, limited documentation of the rationale behind antibiotic prescribing, high use of 'Watch' antibiotics, and limited compliance to STGs among surveyed hospitals requires the urgent instigation of ASPs across Zambia to improve future prescribing.
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Affiliation(s)
- Aubrey C. Kalungia
- Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Moses Mukosha
- Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Chiluba Mwila
- Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - David Banda
- Department of Nursing, Chreso University, Lusaka P.O. Box 37178, Zambia
| | - Matthews Mwale
- Department of Clinical Care & Diagnostic Services, Ministry of Health, Lusaka P.O Box 30205, Zambia
| | - Solomon Kagulura
- The World Bank, Zambia Country Office, Lusaka P.O Box 35410, Zambia
| | - Olanyika O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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14
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Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, Meyer JC. A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications. Hosp Pract (1995) 2022; 50:306-317. [PMID: 35980901 DOI: 10.1080/21548331.2022.2114251] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 10/15/2022]
Abstract
OBJECTIVE Up to 90% of antimicrobials globally are prescribed and dispensed in ambulatory care. However, there are considerable gaps regarding the extent and rationale for their use especially in low- and middle-income countries such as South Africa. Point prevalent surveys (PPS) are useful to determine current prescribing patterns, identify targets for quality improvement and evaluate the effectiveness of antimicrobial stewardship programmes (ASPs) within institutions. Consequently, the objective of this study was to undertake a PPS within community healthcare centers (CHCs) in South Africa given their importance to the public healthcare system. The findings will be used to provide guidance on future interventions to improve antimicrobial use in South Africa and wider. METHODS A PPS of antimicrobial consumption was undertaken among patients attending 18 CHCs in South Africa. A web-based application was used to record the utilization data, with utilization assessed against World Health Organization (WHO) and South African guidelines. RESULTS The overall prevalence of antimicrobial use amongst patients attending the CHCs was 21.5% (420 of 1958 patients). This included one or more antimicrobials per patient. The most frequently prescribed antimicrobials were amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%), with the majority from the WHO Access list of antibiotics. There was high adherence to guidelines (93.4%). The most common indication for antibiotics were ear, nose and throat infections (22.8%), with no culture results recorded in patients' files. CONCLUSIONS It's encouraging to see high adherence to South African guidelines when antimicrobials were prescribed, with the majority taken from the WHO Access list. However, there were concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections that are essentially viral in origin, and a lack of microbiological testing. The establishment of ASPs can help address identified concerns through designing and implementing appropriate interventions.
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Affiliation(s)
- Phumzile P Skosana
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Danie Kruger
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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15
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Allocati E, Godman B, Gobbi M, Garattini S, Banzi R. Switching Among Biosimilars: A Review of Clinical Evidence. Front Pharmacol 2022; 13:917814. [PMID: 36091837 PMCID: PMC9449694 DOI: 10.3389/fphar.2022.917814] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Biological medicines have improved patients’ outcomes, but their high costs may limit access. Biosimilars, alternatives that have demonstrated high similarity in terms of quality, safety, and efficacy to an already licensed originator biological product, could increase competition and decrease prices. Given the expanding number of biosimilars, patients may switch from originator to biosimilar or among biosimilars. Randomized trials and observational studies conducted with multiple biosimilars over many disease areas confirmed the safety and efficacy of switching from originator to biosimilar. This study summarizes evidence on switching between biosimilars for which there are concerns to provide future guidance. A systematic search (MEDLINE, Embase, and Cochrane Library) for studies on anti-TNF agents, assessing clinical efficacy and safety of biosimilar-to-biosimilar switch in chronic inflammatory diseases, was performed. We retrieved 320 records and included 19 clinical studies. One study with historical control compared switching between biosimilars to maintenance of the same biosimilar. Ten were controlled cohort studies comparing switching between two biosimilars vs. switching from originator to a biosimilar or vs. multiple switches. Eight were single-arm cohort studies, where participants switched from one biosimilar to another, and the outcomes were compared before and after the switch. Overall, these studies did not highlight significant concerns in switching between biosimilars. Therefore, switching studies seem difficult to perform and unnecessary with the body of evidence suggesting no real problems in practice coupled with stringent regulatory requirements. Monitoring the use of biosimilars in clinical practice could support clinical decision-making, rational use of biological medicines, and help to further realize possible savings.
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Affiliation(s)
- Eleonora Allocati
- Center for Health Regulatory Policies, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
- *Correspondence: Eleonora Allocati,
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Marco Gobbi
- Laboratory of Pharmacodynamics and Pharmacokinetics, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Silvio Garattini
- Presidency, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Rita Banzi
- Center for Health Regulatory Policies, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
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16
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Hu Y, Song Z, Jiang D, Zhuo L, Cheng Y, Zhao R. Knowledge, Attitudes and Practice of Healthcare Providers, Healthcare Regulatory Practitioners and Patients Toward Biosimilars in China: Insights From a Nationwide Survey. Front Pharmacol 2022; 13:876503. [PMID: 35721219 PMCID: PMC9201466 DOI: 10.3389/fphar.2022.876503] [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: 02/15/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: With increasing numbers of biosimilars entering the market or in the approval pipeline in China, understanding the current awareness and attitudes of biosimilars still remains the first step to promote uptake. This study aims to investigate the knowledge, attitudes and practices (KAP) of multiple stakeholders toward biosimilars, including healthcare providers (HCPs), healthcare regulatory practitioners and patients, and to provide practical information for future uptake of biosimilars in China. Methods: This nationwide cross-sectional online survey was conducted in mainland China. The questionnaire with a high level of reliability and validity was designed based on previous studies and clinical questions in the Clinical Practice Guideline for Clinical Application of Biosimilars. Logistic regression model was employed to identify possible impact factors, and Spearman’s rank correlation test was used to identify the correlation between knowledge and attitudes. Chi-squared test was used to compare the differences between different stakeholders. Results: Overall, 599 valid respondents were recruited, of whom 77.63%, 7.01% and 15.36% were HCPs, healthcare regulatory practitioners and patients, respectively. A total of 504 respondents who had heard of biosimilars were included in the KAP analysis. 76.70% of HCPs, 90.24% of healthcare regulatory practitioners and 50.98% of patients had good knowledge about the definition, while less familiarity with the development process and regulations on interchangeability and indication extrapolation was found in the former two groups. For attitudes toward biosimilars, an overall lack of positivity was shown, as only 18.20% HCPs, 14.63% healthcare regulatory practitioners and 23.53% patients were classified as having positive attitudes. More specifically, most respondents were positive about the influence of payment policy on the uptake of biosimilars, but they showed a neutral attitude toward the clinical medication and interchangeability of biosimilars. Efficacy, safety, immunogenicity, interchangeability and indication extrapolation are major concerns when utilizing biosimilars. Regarding practice, our study showed an inadequate utilization of biosimilars in China. Several further suggestions on the regulation of biosimilars were proposed by healthcare regulatory practitioners. Conclusions: There is still plenty of room for improvement of knowledge, attitudes and practice toward biosimilars among multiple stakeholders in China, which can be improved through high-quality real world evidence, educational programs and other effective measures directed towards barriers.
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Affiliation(s)
- Yang Hu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zaiwei Song
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Dan Jiang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lin Zhuo
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicology Center, Peking University, Beijing, China
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17
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Xoxi E, Rumi F, Kanavos P, Dauben HP, Gutierrez-Ibarluzea I, Wong O, Rasi G, Cicchetti A. A Proposal for Value-Based Managed Entry Agreements in an Environment of Technological Change and Economic Challenge for Publicly Funded Healthcare Systems. Front Med Technol 2022; 4:888404. [PMID: 35782579 PMCID: PMC9245041 DOI: 10.3389/fmedt.2022.888404] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Managed entry agreements (MEA) represent one of the main topics of discussion between the European National Payers Authorities. Several initiatives on the subject have been organized over the past few years and the scientific literature is full of publications on the subject. There is currently little international sharing of information between payers, mainly as a result of the confidentiality issues. There are potential benefits from the mutual sharing of information, both about the existence of MEAs and on the outcomes and results. The importance of involving all the players in the decision-making process on market access for a medicinal product (MP) is that it may help to make new therapies available to patients in a shorter time. The aim of this project is to propose a new pathway of value-based MEA (VBMEA), based on the analysis of the current Italian pricing and reimbursement framework. This requires elaboration of a transparent appraisal and MEA details with at least a 24-month contract. The price of the MP is therefore valued based on the analysis of the VBMEA registries of the Italian Medicines Agency. Although the proposal focuses on the Italian context, a similar approach could also be adapted in other nations, considering the particularities of the single health technology assessment (HTA)/payer system.
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Affiliation(s)
- Entela Xoxi
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Rumi
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Filippo Rumi
| | - Panos Kanavos
- London School of Economics and Political Science, London, United Kingdom
| | - Hans-Peter Dauben
- Rheinische Fachhochschule Köln, University for Applied Science, Köln, Germany
| | - Iñaki Gutierrez-Ibarluzea
- BIOEF, Public Foundation of the Department of Health to Promote Innovation and Research in Euskadi, Bilbao, Spain
| | | | - Guido Rasi
- Clinical Trial Center, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Americo Cicchetti
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Huang T, Bai L, Wushouer H, Wang Z, Yang M, Lin H, Shen P, Guan X, Shi L. Clinical Outcome and Medical Cost of Originator and Generic Antihypertensive Drugs: A Population-Based Study in Yinzhou, China. Front Pharmacol 2022; 13:757398. [PMID: 35295329 PMCID: PMC8920543 DOI: 10.3389/fphar.2022.757398] [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: 08/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The substitution of generic drugs can effectively alleviate the rapid growth of drug costs; however, the clinical effectiveness and medical costs of originator products and generics were barely studied in China. Objectives: To compare the effectiveness of antihypertensive drugs and hypertension-related medical costs between originator and generic initiators in Yinzhou, China. Methods: We conducted a population-based retrospective cohort study using the Chinese Electronic Health Records Research in Yinzhou (CHERRY), from July 1, 2011, to December 31, 2018. Hypertension patients initiating with originator products were compared with patients initiating with generic counterparts. We used 1:1 propensity score matching to pair the two groups based on sociodemographic, clinical, and health service utilization variables. Cox proportional regression was adopted to compare the rate of hospitalization for hypertension-related cardiovascular disease between matched originator and generic initiators. Wilcoxon matched-pairs signed-rank test was used to compare annual hypertension-related medical costs. Results: Matched pairs (10,535) of patients were included in the comparative study of originator products and generics, corresponding to seven antihypertensive drugs including amlodipine, felodipine, nifedipine, irbesartan, losartan, valsartan, and metoprolol. The average age of patients included in the analysis was around 60 years (originator vs. generics initiators: from 59.0 vs. 59.1 years in losartan to 62.9 vs. 63.6 years in nifedipine). Higher hospitalization rates among originator initiators were observed for three calcium channel blockers (hazard ratio[95% CI]: amlodipine, 3.18[1.43, 7.11]; felodipine, 3.60[1.63, 7.98]; and nifedipine, 3.86[1.26, 11.81]; respectively). The remaining four out of seven drugs of the clinical endpoint estimates showed comparable outcomes between originator products and generics (hazard ratio[95% CI]: irbesartan, 1.19[0.50, 2.84]; losartan, 1.84[0.84, 4.07]; valsartan, 2.04[0.72, 5.78]; and metoprolol, 1.25[0.56, 2.80]; respectively). Higher median annual hypertension-related medical costs were observed in originator initiators (all p < 0.001), except for metoprolol (p = 0.646). Conclusion: We observed comparable or even better clinical outcomes and less medical cost associated with the use of antihypertensive generics compared to originator counterparts. This could help increase patient and provider confidence in the efficacy of generic medicines to manage hypertension diseases.
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Affiliation(s)
- Tao Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Zhiyuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Mingchun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
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19
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Barberato-Filho S, Bergamaschi CDC, Godman B, Silva MT, Del Fiol FDS, Baldoni AO, Barreto JOM, Lopes LC. Editorial: New Horizons in Health-Promoting: From Methods to Implementation Science. Front Pharmacol 2022; 12:830957. [PMID: 35095538 PMCID: PMC8795761 DOI: 10.3389/fphar.2021.830957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Silvio Barberato-Filho
- Pharmaceutical Science Graduate Course, University of Sorocaba (Uniso), Sorocaba, Brazil
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, AlAin, United Arab Emirates.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Marcus Tolentino Silva
- Pharmaceutical Science Graduate Course, University of Sorocaba (Uniso), Sorocaba, Brazil
| | | | | | | | - Luciane Cruz Lopes
- Pharmaceutical Science Graduate Course, University of Sorocaba (Uniso), Sorocaba, Brazil
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20
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Chowdhury K, Haque M, Nusrat N, Adnan N, Islam S, Lutfor AB, Begum D, Rabbany A, Karim E, Malek A, Jahan N, Akter J, Ashraf S, Hasan MN, Hassan M, Akhter N, Mazumder M, Sihan N, Naher N, Akter S, Zaman SU, Chowdhury T, Nesa J, Biswas S, Islam MD, Hossain AM, Rahman H, Biswas PK, Shaheen M, Chowdhury F, Kumar S, Kurdi A, Mustafa ZU, Schellack N, Gowere M, Meyer JC, Opanga S, Godman B. Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study. Antibiotics (Basel) 2022; 11:antibiotics11010105. [PMID: 35052982 PMCID: PMC8772946 DOI: 10.3390/antibiotics11010105] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 02/07/2023] Open
Abstract
There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.
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Affiliation(s)
- Kona Chowdhury
- Department of Paediatrics, Gonoshasthaya Samaj Vittik Medical College and Hospital, Savar, Dhaka 1344, Bangladesh;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia
- Correspondence: (M.H.); (B.G.); Tel.: +60-3-9051-3400 (ext. 2257) (M.H.); +44-141-548-3825 (B.G.)
| | - Nadia Nusrat
- Department of Paediatrics, Delta Medical College and Hospital, 26/2, Principal Abul Kashem Road, Mirpur-1, Dhaka 1216, Bangladesh;
| | - Nihad Adnan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (N.A.); (S.I.); (S.U.Z.)
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (N.A.); (S.I.); (S.U.Z.)
| | - Afzalunnessa Binte Lutfor
- Department of Microbiology, Ad-Din Women’s Medical College, 2 Boro Mogbazar, Dhaka 1217, Bangladesh;
| | - Dilara Begum
- Depatment of Paediatrics, Dhaka Medical College Hospital, 100 Ramna Central Shaheed Minar Area, Bakshi Bazar, Dhaka 1000, Bangladesh;
| | - Arif Rabbany
- Department of Paediatrics, Mymensnigh Medical College Hospital, Dhaka-Mymensingh Road, Mymensingh Sadar, Mymensingh 2200, Bangladesh;
| | - Enamul Karim
- Department of Paediatrics, US-Bangla Medical College, Kornogop, Tarabo, Rupganj, Narayangonj 1460, Bangladesh;
| | - Abdul Malek
- Department of Pediatrics, Green Life Medical College Hospital, Dhaka 1205, Bangladesh;
| | - Nasim Jahan
- Department of Pediatrics, Asgar Ali Hospital, Distillary Road, Ganderia, Dhaka 1204, Bangladesh;
| | - Jesmine Akter
- Department of Pediatrics, Bangladesh Specialized Hospital, Mirpur Road, Dhaka 1207, Bangladesh;
| | - Sumala Ashraf
- Department of Paediatrics, Holy Family Red Crescent Medical College Hospital, 1-Eskaton Garden Road, Dhaka 1000, Bangladesh;
| | - Mohammad Nazmul Hasan
- Department Paediatric Surgery, Cumilla Medical College Hospital, Cumilla 3500, Bangladesh;
| | - Mahmuda Hassan
- Department of Paediatrics, Ad-din Women’s Medical College, 2 Boro Mogbazar, Dhaka 1217, Bangladesh;
| | - Najnin Akhter
- Department of Pediatrics, Cumilla Medical College Hospital, Cumilla 3500, Bangladesh; (N.A.); (N.S.)
| | - Monika Mazumder
- Department of Pediatrics, Rangpur Medical College, Rangpur 5400, Bangladesh;
| | - Nazmus Sihan
- Department of Pediatrics, Cumilla Medical College Hospital, Cumilla 3500, Bangladesh; (N.A.); (N.S.)
| | - Nurun Naher
- Department of Pediatrics, Evercare Hospital, Plot-81, Block-E, Bashundhara Residential Area, Dhaka 1229, Bangladesh;
| | - Shaheen Akter
- Department of Pediatrics, Enam Medical College and Hospital, Savar, Dhaka 1340, Bangladesh;
| | - Sifat Uz Zaman
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (N.A.); (S.I.); (S.U.Z.)
| | - Tanjina Chowdhury
- Department of Pediatrics, Sylhet M.A.G. Osmani Medical College Hospital, Medical College Road, Kajolshah, Sylhet 3100, Bangladesh;
| | - Jebun Nesa
- Department of Paediatrics, Center for Women and Child Health, Savar, Dhaka 1349, Bangladesh;
| | - Susmita Biswas
- Department of Paediatrics, Chattogram Medical College Hospital, Panchlaish, Chattogram 4203, Bangladesh; (S.B.); (M.S.)
| | - Mohammod Didarul Islam
- Department of Paediatrics, Shaheed Syed Nazrul Islam Medical College, Kishorganj 2300, Bangladesh;
| | - Al Mamun Hossain
- Department of Paediatrics, Satkhira Medical College Hospital, Baka, Satkhira 9400, Bangladesh;
| | - Habibur Rahman
- Department of Paediatrics, Meherpur District Hospital, Meherpur 7100, Bangladesh;
| | - Palash Kumar Biswas
- Department of Paediatrics, Jashore Medical College Hospital, Jessore 7400, Bangladesh;
| | - Mohammed Shaheen
- Department of Paediatrics, Chattogram Medical College Hospital, Panchlaish, Chattogram 4203, Bangladesh; (S.B.); (M.S.)
| | - Farah Chowdhury
- Department of Paediatrics, Chattogram Ma Shishu Hospital Medical College, Chattogram 4100, Bangladesh;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil 44001, Iraq
| | - Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan;
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa; (N.S.); (M.G.)
| | - Marshall Gowere
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0007, South Africa; (N.S.); (M.G.)
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi 00202, Kenya;
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
- Correspondence: (M.H.); (B.G.); Tel.: +60-3-9051-3400 (ext. 2257) (M.H.); +44-141-548-3825 (B.G.)
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21
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Mardare I, Campbell SM, Meyer JC, Sefah IA, Massele A, Godman B. Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care. Front Pharmacol 2022; 12:794363. [PMID: 35095504 PMCID: PMC8795368 DOI: 10.3389/fphar.2021.794363] [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: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.
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Affiliation(s)
- Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Stephen M. Campbell
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Israel Abebrese Sefah
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Amos Massele
- Pharmacology and Therapeutics Department, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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22
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Cheikh-Moussa K, Caro Mendivelso J, Carrillo I, Astier-Peña MP, Olivera G, Silvestre C, Nuín M, Mira JJ. Frequency and estimated costs of ten low-value practices in the Spanish Primary Care: a retrospective study. Expert Opin Drug Saf 2022; 21:995-1003. [PMID: 35020555 DOI: 10.1080/14740338.2022.2026924] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The frequency of low-value practices (LVPs) in the healthcare system is a worldwide challenge. Far less is known about the related extra cost. This study aimed to evaluate the LVPs trend in Spanish primary care (PC), its frequency in both sexes, and estimate its related extra cost. METHODS A multicentric, retrospective, and national research project was conducted. Ten LVPs highly frequent and potentially harmful for patients were analyzed. Algorithms were applied to collect the data from 28,872,851 episodes registered into national databases (2015-2017). Cost estimation was made. RESULTS LVPs registered a total of 7,160,952 (26.5%) episodes plus a total of 259,326 avoidable PSA screening tests. In adults, a high frequency was found for prescription of 1g paracetamol >3 days, antibiotics for acute bronchitis (unconfirmed comorbidity), and benzodiazepines in patients >65 years with insomnia. Women received more jeopardizing practices (p≤0.001). Pediatrics presented a downward of antibiotic and paracetamol-ibuprofen prescription combination. The estimated extra cost was close to €292 million (2.8% of the total cost in PC). CONCLUSION LVPs reduction during the analyzed period was moderate compared to studies following 'Choosing Wisely list' of LVPs and must improve to reduce patient risk and the extra related costs.
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Affiliation(s)
- Kamila Cheikh-Moussa
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Sant Joan d'Alacant, Spain
| | - Johanna Caro Mendivelso
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Irene Carrillo
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - María Pilar Astier-Peña
- Family and Community Medicine, Universitas Health Centre, Zaragoza I Sector, Aragonese Health Service (SALUD), Zaragoza, Spain.,University of Zaragoza, Aragon Health Research Institute (IISA), Zaragoza, Spain
| | | | - Carmen Silvestre
- Healthcare Effectiveness and Safety Service, Navarre Health Service-Osasunbidea, Pamplona, Spain
| | - Marian Nuín
- Healthcare Effectiveness and Safety Service, Navarre Health Service-Osasunbidea, Pamplona, Spain
| | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University, Elche, Spain.,Health District Alicante-Sant Joan, Alicante, Spain.,REDISSEC, Spain
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23
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Mokwele RN, Schellack N, Bronkhorst E, Brink AJ, Schweickerdt L, Godman B. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlab196. [PMID: 35146427 PMCID: PMC8826632 DOI: 10.1093/jacamr/dlab196] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background Objectives Patients and methods Results Conclusions
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Affiliation(s)
- R. Nelly Mokwele
- School of Pharmacy, Division of Clinical Pharmacy, Sefako Makgatho Health Sciences University, South Africa
| | - Natalie Schellack
- School of Pharmacy, Division of Clinical Pharmacy, Sefako Makgatho Health Sciences University, South Africa
- Department of Pharmacology, University of Pretoria, South Africa
| | - Elmien Bronkhorst
- School of Pharmacy, Division of Clinical Pharmacy, Sefako Makgatho Health Sciences University, South Africa
| | - Adrian J. Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Louise Schweickerdt
- Skills Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa,Gauteng, South Africa
| | - Brian Godman
- School of Pharmacy, Division of Clinical Pharmacy, Sefako Makgatho Health Sciences University, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
- Corresponding author. E-mail:
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24
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Etando A, Amu AA, Haque M, Schellack N, Kurdi A, Alrasheedy AA, Timoney A, Mwita JC, Rwegerera GM, Patrick O, Niba LL, Boahen-Boaten BB, Tabi FB, Amu OY, Acolatse J, Incoom R, Sefah IA, Guantai AN, Opanga S, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Hango E, Lates J, Fadare J, Ogunleye OO, Saleem Z, Oosthuizen F, Cordier W, Matlala M, Meyer JC, Schellack G, Massele A, Malande OO, Kalungia AC, Sichone J, Banda SS, Zaranyika T, Campbell S, Godman B. Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future. Healthcare (Basel) 2021; 9:1722. [PMID: 34946448 PMCID: PMC8701006 DOI: 10.3390/healthcare9121722] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 10/15/2021] [Revised: 11/19/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction. METHOD An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with. RESULTS Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed. CONCLUSIONS Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments.
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Affiliation(s)
- Ayukafangha Etando
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H100, Eswatini
| | - Adefolarin A Amu
- Department of Pharmacy, Faculty of Health Sciences, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H100, Eswatini
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai, Besi, Kuala Lumpur 57000, Malaysia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, Basic Medical Sciences Building, Prinshof Campus, University of Pretoria, Arcadia 0083, South Africa
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria 0208, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, P.O. Box 178, Erbil 44001, Iraq
| | - Alian A Alrasheedy
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Qassim 51452, Saudi Arabia
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Chair SIGN Council, Healthcare Improvement Scotland, Edinburgh EH12 9EB, UK
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda, Cameroon
- Adelaide University, Adelaide 5005, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda, Cameroon
- Department of Public Health, University of Bamenda, P.O. Box 39, Bambili, Cameroon
| | - Baffour Boaten Boahen-Boaten
- Department of Psychology, Faculty of Applied Social Sciences, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H100, Eswatini
| | - Felicity Besong Tabi
- Department of Social Work, Faculty of Applied Social Sciences, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H100, Eswatini
| | - Olufunke Y Amu
- Department of Social Work, Faculty of Applied Social Sciences, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H100, Eswatini
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Israel Abebrese Sefah
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Anastasia Nkatha Guantai
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, P.O. Box 19676-00202 KNH, Nairobi 00200, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, P.O. Box 19676-00202 KNH, Nairobi 00200, Kenya
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek 10000, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek 10000, Namibia
| | - Ester Hango
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek 10000, Namibia
| | - Jennie Lates
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek 10000, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti 362001, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti 362001, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, Lagos State University, Ikeja, Lagos 21266, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 101233, Nigeria
| | - Zikria Saleem
- Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Werner Cordier
- Department of Pharmacology, Faculty of Health Sciences, Basic Medical Sciences Building, Prinshof Campus, University of Pretoria, Arcadia 0083, South Africa
| | - Moliehi Matlala
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria 0208, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria 0208, South Africa
| | | | - Amos Massele
- Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam, Tanzania
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Kampala, Uganda
| | | | - James Sichone
- Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia
| | - Sekelani S Banda
- Department of Medical Education Development, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 20550, United Arab Emirates
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Vella Bonanno P, Cassar V, Godman B. A Review of the Evidence on Attitudes, Perceived Impacts and Motivational Factors for European Member State Collaboration for Pricing and Reimbursement of Medicines: Time for the EEA Member States to Apply Their Experience and Expertise in Evidence-Based Decision Making to Their Current Pharmaceutical Policy Challenges. Front Pharmacol 2021; 12:666405. [PMID: 34867312 PMCID: PMC8633953 DOI: 10.3389/fphar.2021.666405] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
In 2018/2019 there were a number of initiatives for collaboration between Member States in the European Economic Area (EEA) and the European Commission published a Proposal for a Regulation on Health Technology Assessment. In view of the perceived benefits from collaboration, the experiences and challenges of these collaborative initiatives and the possible implications of the proposed legislation, a study of the evidence on attitudes, perceived impacts and the motivational factors towards European Member State collaboration regarding the pricing and reimbursement of medicines was conducted. This study adopted an evidence-based management approach by Barends and Rousseau. The main findings showed that Member States differed in their motivation for collaboration for different pharmaceutical activities. Member States favoured voluntary co-operation for all activities of pricing and reimbursement except for relative effectiveness assessments where Member State authorities had divergent attitudes and prioritised activities related to the sustainability of their healthcare systems and access to medicines. Contrastingly pharmaceutical companies strongly favoured mandatory cooperation for evaluation. Member States motivation for collaboration was highly dependent on the purpose, political will, implementation climate and cultural factors. Currently, with the experiences of ongoing collaborations, following the progress of the discussion at Council, and with a number of inititatives for new pharmaceutical strategy and policy, it is proposed that Member States use their trust, expertise and knowledge of application of evidence-based decision making for pricing and reimbursement of medicines and apply it to decide the future model for Member State collaboration. The applicability of principles of evidence-based management to pharmaceutical policy can be used as a starting point.
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Affiliation(s)
- Patricia Vella Bonanno
- Department of Management, Faculty of Economics, Management and Accountancy, University of Malta, Msida, Malta
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Vincent Cassar
- Department of Management, Faculty of Economics, Management and Accountancy, University of Malta, Msida, Malta
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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26
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Godman B, Wladysiuk M, McTaggart S, Kurdi A, Allocati E, Jakovljevic M, Kalemeera F, Hoxha I, Nachtnebel A, Sauermann R, Hinteregger M, Marković-Peković V, Tubic B, Petrova G, Tachkov K, Slabý J, Nejezchlebova R, Krulichová IS, Laius O, Selke G, Langner I, Harsanyi A, Inotai A, Jakupi A, Henkuzens S, Garuolienė K, Gulbinovič J, Bonanno PV, Rutkowski J, Ingeberg S, Melien Ø, Mardare I, Fürst J, MacBride-Stewart S, Holmes C, Pontes C, Zara C, Pedrola MT, Hoffmann M, Kourafalos V, Pisana A, Banzi R, Campbell S, Wettermark B. Utilisation Trend of Long-Acting Insulin Analogues including Biosimilars across Europe: Findings and Implications. Biomed Res Int 2021; 2021:9996193. [PMID: 34676266 PMCID: PMC8526244 DOI: 10.1155/2021/9996193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. RESULTS Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. CONCLUSIONS There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Magdalene Wladysiuk
- Chair of Epidemiology and Preventive Medicine, Medical College, Jagiellonian University, Krakow, Poland
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Stuart McTaggart
- Public Health Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Mihajlo Jakovljevic
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- Institute of Comparative Economic Studies, Faculty of Economics, Hosei University Tokyo, Tokyo, Japan
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Anna Nachtnebel
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Robert Sauermann
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Manfred Hinteregger
- Dachverband der Österreichischen Sozialversicherungen, Kundmanngasse 21, AT-1030 Vienna, Austria
| | - Vanda Marković-Peković
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Biljana Tubic
- Faculty of Medicine, Department of Medicinal Chemistry, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Agency for Medicinal Product and Medical Devices of Bosnia and Herzegovina, 78000 Banja Luka, Bosnia and Herzegovina
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Juraj Slabý
- State Institute for Drug Control, Prague, Czech Republic
| | | | - Iva Selke Krulichová
- Department of Medical Biophysics, Faculty of Medicine in Hradec Králové, Charles University, Simkova 870, 500 03 Hradec Králové, Czech Republic
| | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411 Tartu, Estonia
| | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Irene Langner
- Wissenschaftliches Institut der AOK (WIdO), Rosenthaler Straße 31, 10178 Berlin, Germany
| | - András Harsanyi
- Department of Health Policy and Health Economics, Eotvos Lorand University, Budapest, Hungary
| | - András Inotai
- Syreon Research Institute and Semmelweis University, Center of Health Technology Assessment, Budapest, Hungary
| | - Arianit Jakupi
- Faculty of Pharmacy, UBT Higher Education Institute, Pristina, Kosovo
| | | | - Kristina Garuolienė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Gulbinovič
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Health Services Management, University of Malta, Valletta, Malta
| | - Jakub Rutkowski
- HTA Consulting, Starowiślna Str. 17/3, 31-038 Krakow, Poland
| | - Skule Ingeberg
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Øyvind Melien
- Medicines Committee, Oslo University Hospitals, Oslo, Norway
| | - Ileana Mardare
- Faculty of Medicine, Public Health and Management Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 050463 Bucharest, Romania
| | - Jurij Fürst
- Health Insurance Institute, Miklosiceva 24, SI-1507 Ljubljana, Slovenia
| | | | | | - Caridad Pontes
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corinne Zara
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | - Marta Turu Pedrola
- Drug Department, Catalan Health Service, Gran Via de les Corts Catalanes, 08007 Barcelona, Spain
| | | | - Vasileios Kourafalos
- National Organization for the Provision of Healthcare Services (EOPYY), Athens, Greece
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rita Banzi
- Istituto di Ricerche Farmacologiche ‘Mario Negri' IRCCS, Milan, Italy
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bjorn Wettermark
- Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University, Uppsala, Sweden
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27
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Engler D, Meyer JC, Schellack N, Kurdi A, Godman B. Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction. Antibiotics (Basel) 2021; 10:antibiotics10080996. [PMID: 34439046 PMCID: PMC8388942 DOI: 10.3390/antibiotics10080996] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022] Open
Abstract
Antimicrobial resistance (AMR) is a growing problem worldwide, including South Africa, where an AMR National Strategy Framework was implemented to instigate antimicrobial stewardship programmes (ASPs) and improve antimicrobial prescribing across sectors. To address the need to assess progress, a sequential mixed methodology with an explanatory research design was employed. In Phase 1, a self-administered questionnaire was completed by healthcare professionals (HCPs) from 26 public sector healthcare facilities across South Africa to assess compliance with the Framework. The results were explored in Phase 2 through 10 focus group discussions and two in-depth interviews, including 83 participants. Emerging themes indicated that public healthcare facilities across South Africa are facing many challenges, especially at entry level primary healthcare (PHC) facilities, where antimicrobial stewardship activities and ASPs are not yet fully implemented. Improved diagnostics and surveillance data are a major shortcoming at these facilities. Continuous education for HCPs is deficient, especially for the majority of prescribers at PHC level and health campaigns are nearly non-existent. Involvement and visibility of management at certain facilities is a serious shortfall. Consequently, it is important to call attention to the challenges faced with improving antimicrobial prescribing across countries and address these to reduce AMR, especially in PHC facilities, being the first point of access to healthcare for the vast majority of patients in developing countries.
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Affiliation(s)
- Deirdré Engler
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Correspondence:
| | - Johanna Catharina Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
| | - Natalie Schellack
- Department of Pharmacology, University of Pretoria, Arcadia 0007, South Africa;
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- School of Pharmaceutical Sciences, University Sains Malaysia, George Town 118000, PNG, Malaysia
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