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1.
Artigo em Russo | MEDLINE | ID: mdl-32119219

RESUMO

The article considers topical aspects of formation of motivational and stimulating component of remuneration in non-state health care institutions. This organizational legal type of medical organization presupposes specific characteristics of financial economic functioning and processes of organization of remuneration fund. In Russia, state and municipal medical organizations provide own sources of motivational component, that much more depend on implementation of mandatory medical insurance territorial programs. In case of non-state clinics quite different sources of employees' incentives of improving quality and productivity of labor exist. The non-state health care institutions occupy in-between position with their financial opportunities between state (municipal) and private structures. Most non-state health care institutions are of departmental subordination. The article deals with issues of development of motivational and incentive mechanisms as exemplified by JSC "Russian Railways". The empirical research permitted to specify in detail algorithm of process of organization of remuneration fund with designation of system of indicators for bonuses distribution. The specific characteristics of development of motivational and incentive systems of remuneration fund in non-state health care institutions are identified.


Assuntos
Assistência à Saúde , Motivação , Remuneração , Assistência à Saúde/organização & administração , Federação Russa
2.
BMC Health Serv Res ; 20(1): 48, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959157

RESUMO

BACKGROUND: This study assessed the association of remuneration systems of paid-for-performance Accredited Social Health Activists (ASHAs) and salaried Anganwadi workers (AWWs) on seven maternal health outcomes in four states in India: Andhra Pradesh (AP), Chhattisgarh, Odisha (Orissa), and Uttar Pradesh (UP). METHODS: The cross-sectional study surveyed mothers of children aged 6-23 months. A total of 3455 mothers were selected via multistage cluster sampling. The seven health outcomes related to the community health worker (CHW) visits were: institutional delivery, complete immunization, exclusive breastfeeding for six months, timely introduction of complementary feeding, continued breastfeeding during child's illness, handwashing, and awareness of Nutrition and Health Days (NHDs). RESULTS: The results varied by state. Mothers who received ASHA visits were significantly less likely to have an institutional delivery, timely introduction of complementary feeding, awareness of Nutrition and Health Days (NHDs), proper handwashing, and exclusive breastfeeding for the first six months in at least one of the four states. Conversely, AWW's home visits were positively predictive of the following health outcomes in certain states: complete immunization for index child, continued breastfeeding during the child's illness, handwashing, and awareness of NHDs. CONCLUSIONS: ASHAs' home visits were not more strongly associated with health outcomes for which they were paid than outcomes for which they were unpaid. AWWs' home visits were positively associated with awareness of NHDs, and associations varied for other recommended health behaviors. Further research could elucidate the causes for successes and failures of CHW programs in different states of India.


Assuntos
Agentes Comunitários de Saúde/economia , Promoção da Saúde/métodos , Saúde Materna/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Remuneração , Adulto , Estudos Transversais , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino
4.
Ger Med Sci ; 17: Doc10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31728135

RESUMO

The objective of clinical trials is to transfer findings gained from basic research to patients and to result in innovative treatment approaches. Along with basic research, results from clinical trials thus represent a core area of medical advances. As a location for clinical trials, Germany is currently well-positioned and internationally competitive. This is evident in its position as No. 2 in Europe and No. 3 worldwide - behind the US and UK - in clinical trials of pharmaceuticals [1]. Maintaining and further improving this favorable positioning as a location for clinical trials is in the mutual interest of all parties involved in the field of clinical research, patients, trial sites and sponsors of clinical trials. For patients, clinical trials offer opportunities to gain early access to innovative therapy options. In addition to the scientific interest from medical faculties, clinical research is thereby an important aspect for university clinics in Germany as they fulfill their medical care mandate. Their involvement in clinical trials gives physicians the ability to gather experience with new treatment approaches at an early stage and to pass this know-how on to their patients. A location's clinical research is thus an important competitive factor in terms of international comparison as well. Industry likewise benefits from the favorable research infrastructure in Germany, which provides rapid patient recruitment and outstanding quality of results obtained and can thus contribute to the early approval of new drugs. From the perspective of the authors, it is therefore essential that Germany continues to remain competitive as a location for conducting clinical trials, precisely because the number of clinical trials is decreasing overall. Companies themselves are in international competition internally and externally, which often creates a certain pressure on trial preparation and thus on the start of a clinical trial. To ensure that a clinical trial can begin early, it is essential that contracts related to the trial are concluded quickly and simply, including remuneration for participants and full, transparent and comprehensible coverage of content for the business relationship. The swift agreement of key contractual and budgetary aspects is therefore in the interest of everyone involved. Against this backdrop, the German Association of Medical Faculties (MFT), the German Association of Academic Medical Centers (VUD), the Coordination Center for Clinical Studies (KKS-Netzwerk) and the German Association of Research-Based Pharmaceutical Companies (vfa) have held joint discussions regarding an important aspect of the contract negotiations - the cost consideration of clinical trials. As a result of these talks, these organizations have developed and published joint "Recommendations for the preparation of a total services calculation for remuneration related to the conduct of a clinical trial in a trial center" [2], [3]. The parties concerned share the conviction that, against the backdrops described, it would be helpful if the potential contract partners had access to recommendations that offer examples of constantly recurring cost positions in order to more precisely determine remuneration related to the conduct of a clinical trial. This article explains how the "Recommendations for the preparation of a total services calculation for remuneration related to the conduct of a clinical trial in a trial center" [2], [3] were developed and provides an overview of their content.


Assuntos
Ensaios Clínicos como Assunto/organização & administração , Contratos , Ensaios Clínicos como Assunto/economia , Contratos/economia , Contratos/normas , Indústria Farmacêutica/economia , Indústria Farmacêutica/organização & administração , Alemanha , Humanos , Remuneração
5.
Am J Bioeth ; 19(9): 21-31, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31419191

RESUMO

The idea that payment for research participation can be coercive appears widespread among research ethics committee members, researchers, and regulatory bodies. Yet analysis of the concept of coercion by philosophers and bioethicists has mostly concluded that payment does not coerce, because coercion necessarily involves threats, not offers. In this article we aim to resolve this disagreement by distinguishing between two distinct but overlapping concepts of coercion. Consent-undermining coercion marks out certain actions as impermissible and certain agreements as unenforceable. By contrast, coercion as subjection indicates a way in which someone's interests can be partially set back in virtue of being subject to another's foreign will. While offers of payment do not normally constitute consent-undermining coercion, they do sometimes constitute coercion as subjection. We offer an analysis of coercion as subjection and propose three possible practical responses to worries about the coerciveness of payment.


Assuntos
Coerção , Análise Ética , Seleção de Pacientes/ética , Remuneração , Sujeitos da Pesquisa , Humanos
6.
Am J Bioeth ; 19(9): 11-20, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31419192

RESUMO

A growing literature documents the existence of individuals who make a living by participating in phase I clinical trials for money. Several scholars have noted that the concerns about risks, consent, and exploitation raised by this phenomenon apply to many (other) jobs, too, and therefore proposed improving subject protections by regulating phase I trial participation as work. This article contributes to the debate over this proposal by exploring a largely neglected worry. Unlike most (other) workers, subjects are not paid to produce or achieve anything but to have things done to them. I argue that this passivity is problematic for reasons of distributive justice. Specifically, it fails to enable subjects to realize what Gheaus and Herzog call "the goods of work"-a failure not offset by adequate opportunities to realize these goods outside of the research context. I also consider whether granting subjects worker-type protections would accommodate this concern.


Assuntos
Ensaios Clínicos Fase I como Assunto/economia , Ensaios Clínicos Fase I como Assunto/ética , Emprego , Remuneração , Sujeitos da Pesquisa , Trabalho , Ética em Pesquisa , Humanos , Salários e Benefícios , Justiça Social , Estados Unidos
8.
Artigo em Russo | MEDLINE | ID: mdl-31465665

RESUMO

In health care, as in other sectors of the public sector, introduced a new system of remuneration (NSOT). However, as the analysis of practice shows, the consequences of its implementation are ambiguous. Despite the growth of the average salary of all categories of medical personnel, its size does not correspond to the planned indicators in most regions of the Russian Federation. The presence in public health organizations of various organizational and legal forms has put institutions in unequal conditions of formation and distribution of funds of the wage Fund. As a result, medical personnel in one region receive different salaries for the same functions. These trends lead to the outflow of personnel from public health institutions in other industries and activities against the backdrop of increased intensification of labor of workers, an increase in the number of functions performed, a significant bureaucratization of their activities. Thus, one of the most important goals of the NSOT to attract and retain specialists in public health has not been achieved. There are serious shortcomings in the construction of basic salaries on the basis of professional qualification groups, due to which the size of the permanent part of the earnings of low-skilled workers in public health may be lower than the minimum wage in the region. One of the most important elements of the new wage system is an effective contract, the introduction of which has led to the fact that the share of variable wages in public health care is unreasonably overstated. It should be noted that in the medical institutions of the public sector there are often no indicators to assess the quality and results of work of employees and the organization as a whole, which leads to problems in determining the criteria for the effectiveness of personnel. Thus, in order to improve the new system of remuneration, it is necessary to eliminate these shortcomings, to develop methodological approaches to the formation of official salaries taking into account the requirements of labor legislation, all decisions in the field of remuneration should have a financial basis.


Assuntos
Assistência à Saúde , Remuneração , Humanos , Renda , Federação Russa , Salários e Benefícios
9.
Transfus Clin Biol ; 26(3): 184-187, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31253495

RESUMO

Among the research developed in social psychology, there is a field of study questioning the mechanisms that explain prosocial behaviors. In 1956, the first links between transfusion medicine and social psychology were formed, with the study of underlying motivations to blood donation behavior. Sixty years later, the number of "fundamental" and "applied" research has widely increased, and we now have a theoretical understanding of blood donation engagement's levers, as well as experimental demonstrations of methods to activate these levers. Thus, the literature offers several strategies experimentally verified to improve the recruitment and retaining of blood donors. These methods can go from specific speeches when soliciting donors, to changes in the blood donation environment, etc. They aim either at impacting the donation experience, at obtaining a change in the donor's behavior, or at changing the determinants of blood donation. Yet, it is clear that the knowledge from the research in social psychology is not really deployed on the field by the organizations that could benefit from it. In this article, we will try to develop the difficulty regarding the application of fundamental and experimental knowledge, and to underline the implications for the blood transfusion establishments. We will then present the psychosocial and cognitive engineering method, and argue its relevance to answer this problematic.


Assuntos
Bancos de Sangue/organização & administração , Doadores de Sangue/psicologia , Inovação Organizacional , Comunicação Persuasiva , Altruísmo , Atitude Frente a Saúde , Doadores de Sangue/provisão & distribução , Transfusão de Sangue/economia , Transfusão de Sangue/psicologia , Comportamento de Ajuda , Humanos , Motivação , Flebotomia/efeitos adversos , Plasma , Remuneração , Síncope Vasovagal/etiologia , Voluntários
10.
PLoS Med ; 16(4): e1002788, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31039158

RESUMO

BACKGROUND: Tuberculosis (TB) still represents a major public health problem in Latin America, with low success and high default rates. Poor adherence represents a major threat for TB control and promotes emergence of drug-resistant TB. Expanding social protection programs could have a substantial effect on the global burden of TB; however, there is little evidence to evaluate the outcomes of socioeconomic support interventions. This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients. METHODS AND FINDINGS: Data were collected on adult patients with first diagnosis of pulmonary TB starting treatment in public healthcare facilities (HCFs) from 16 health departments with high TB burden in Buenos Aires who were followed until treatment completion or abandonment. The main exposure of interest was the registration to receive the CCT. Other covariates, such as sociodemographic and clinical variables and HCFs' characteristics usually associated with treatment adherence and outcomes, were also considered in the analysis. We used hierarchical models, propensity score (PS) matching, and inverse probability weighting (IPW) to estimate treatment effects, adjusting for individual and health system confounders. Of 941 patients with known CCT status, 377 registered for the program showed significantly higher success rates (82% versus 69%) and lower default rates (11% versus 20%). After controlling for individual and system characteristics and modality of treatment, odds ratio (OR) for success was 2.9 (95% CI 2, 4.3, P < 0.001) and default was 0.36 (95% CI 0.23, 0.57, P < 0.001). As this is an observational study evaluating an intervention not randomly assigned, there might be some unmeasured residual confounding. Although it is possible that a small number of patients was not registered into the program because they were deemed not eligible, the majority of patients fulfilled the requirements and were not registered because of different reasons. Since the information on the CCT was collected at the end of the study, we do not know the exact timing for when each patient was registered for the program. CONCLUSIONS: The CCT appears to be a valuable health policy intervention to improve TB treatment outcomes. Incorporating these interventions as established policies may have a considerable effect on the control of TB in similar high-burden areas.


Assuntos
Antituberculosos/uso terapêutico , Política de Saúde , Política Pública , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/economia , Argentina/epidemiologia , Estudos de Coortes , Feminino , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Política de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistemas de Apoio Psicossocial , Política Pública/economia , Remuneração , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/economia , Tuberculose/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
11.
Hum Resour Health ; 17(1): 22, 2019 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-30898136

RESUMO

BACKGROUND: Globally, there is renewed interest in and momentum for strengthening community health systems, as also emphasized by the recent Astana Declaration. Recent reviews have identified factors critical to successful community health worker (CHW) programs but pointed to significant evidence gaps. This review aims to propose a global research agenda to strengthen CHW programs. METHODS AND RESULTS: We conducted a search for extant systematic reviews on any intermediate factors affecting the effectiveness of CHW programs in February 2018. A total of 30 articles published after year 2000 were included. Data on research gaps were abstracted and summarized under headings based on predominant themes identified in the literature. Following this data gathering phase, two technical advisory groups comprised of experts in the field of community health-including policymakers, implementors, researchers, advocates and donors-were convened to discuss, validate, and prioritize the research gaps identified. Research gap areas that were identified in the literature and validated through expert consultation include selection and training of CHWs, community embeddedness, institutionalization of CHW programs (referrals, supervision, and supply chain), CHW needs including incentives and remuneration, governance and sustainability of CHW programs, performance and quality of care, and cost-effectiveness of CHW programs. Priority research questions included queries on effective policy, financing, governance, supervision and monitoring systems for CHWs and community health systems, implementation questions around the role of digital technologies, CHW preferences, and drivers of CHW motivation and retention over time. CONCLUSIONS: As international interest and investment in CHW programs and community health systems continue to grow, it becomes critical not only to analyze the evidence that exists, but also to clearly define research questions and collect additional evidence to ensure that CHW programs are effective, efficient, equity promoting, and evidence based. Generally, the literature places a strong emphasis on the need for higher quality, more robust research.


Assuntos
Planejamento em Saúde Comunitária , Serviços de Saúde Comunitária , Agentes Comunitários de Saúde , Assistência à Saúde/organização & administração , Saúde Global , Pesquisa sobre Serviços de Saúde , Atenção Primária à Saúde , Participação da Comunidade , Análise Custo-Benefício , Assistência à Saúde/normas , Política de Saúde , Prioridades em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Motivação , Remuneração
12.
Tidsskr Nor Laegeforen ; 139(3)2019 02 12.
Artigo em Norueguês | MEDLINE | ID: mdl-30754941

RESUMO

BACKGROUND: A fall in recruitment of participants for research has been observed in recent years. In order to ensure a sufficient number of research participants, incentives such as remuneration and gift cards have been used. The number of Norwegian research groups that apply to use payment has not been previously studied. We have investigated the extent to which payment and other incentives are used in medical and health research in Norway. MATERIAL AND METHOD: Four of the seven Regional Committees for Medical and Health Research Ethics (REC) in Norway were selected to participate in the study. All applications for approval of research projects submitted to these committees in 2014 were analysed. Following a review of the application form, research protocol and information and consent form associated with the project applications, a total of 515 of 955 project applications were included in the study. RESULTS: Of 515 project applications that were included, a total of 12 % applied to use incentives. Altogether 4 % applied to use remuneration and 7 % applied to use incentives such as gift cards, gifts and lottery tickets. Of the project applications involving remuneration, 82 % were for amounts of NOK 500 or less. INTERPRETATION: A minority of the research groups applied to use incentives. The amounts that were planned to be used as incentives were low and appear to be acceptable. It is unlikely that the size of the incentives constitutes an undue influence on research participants in Norway.


Assuntos
Pesquisa Biomédica/economia , Doações , Seleção de Pacientes , Remuneração , Sujeitos da Pesquisa , Comitês de Ética em Pesquisa , Humanos , Consentimento Livre e Esclarecido , Motivação , Noruega , Recompensa
13.
BMJ Open ; 9(1): e024224, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30647042

RESUMO

OBJECTIVES: If patients are to reap the benefits of continued drug development, an understanding of why healthy participants take part in phase I clinical trials is imperative. The current study aimed to explore the nature of these underlying motivations which may, in turn, improve the overall participant experience and assist in the development of more effective recruitment and retention strategies. DESIGN: This study used a qualitative design based on the theory of planned behaviour. Specifically, it explored healthy participants' underlying behavioural, control and normative beliefs which influence their participation in phase I clinical trials. SETTING: This study took place at a company that specialises in conducting phase I and phase II clinical trials in the Australian state of Queensland. PARTICIPANTS: Participants (n=31) were either currently undergoing a phase I clinical trial or had previously taken part in a phase I clinical trial. RESULTS: Results showed that the motivations were varied and not solely centred on financial gains. Reported advantages of participation included altruism, while inconvenience was most often reported as a disadvantage. Friends were reported as those most likely to approve, while one's mother was reported as most likely to disapprove. Having a suitable time frame/flexible scheduling and feeling comfortable taking part in the trial were both the most commonly reported facilitators, while inflexible scheduling/time commitment was the most commonly reported barrier. CONCLUSIONS: Practical implications included the need for organisations involved in clinical trials to be mindful of inflexible scheduling and exploring the possibility of making educational materials available to family members who may be concerned about the risks associated with participation. Overall, it is anticipated that the results of this study will improve the understanding of factors that influence phase I clinical trial participation which may, ultimately, help develop new therapeutics to improve patient health.


Assuntos
Ensaios Clínicos Fase I como Assunto , Voluntários Saudáveis/psicologia , Motivação , Adulto , Idoso , Altruísmo , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Queensland , Remuneração , Fatores de Tempo , Adulto Jovem
15.
JAMA Netw Open ; 2(1): e187377, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30681710

RESUMO

Importance: Industry relationships are an important measure of professional advancement; however, the association between physician sex and industry payments in radiation oncology has not been described. Objective: To update the trends in the sex distribution of industry payments in radiation oncology. Design, Setting, and Participants: This retrospective cross-sectional study was conducted between July 1, 2018, and August 31, 2018. It used the publicly available Centers for Medicare & Medicaid Services (CMS) Open Payments program and CMS Physician and Other Supplier Public Use File databases to obtain 2016 industry payment data for US radiation oncologists who reported receiving industry funding in that year (n = 3052). Total monetary value, number of payments, and median payment amounts were determined for each sex in the following categories: research, consulting, honoraria, industry grants, royalty or license, and services other than consulting. Main Outcomes and Measures: Industry payment amounts among 3052 radiation oncologists who reported receiving payments in 2016; association of median payment with the types of payment by sex. Results: Of the total 4483 radiation oncologists who practiced in 2016, 1164 (25.9%) were female and 3319 (74.0%) were male. Industry payments were distributed among 3052 radiation oncologists (68.1%), of whom 715 (23.4%) were female and 2337 (76.6%) were male. The proportion of female radiation oncologists who received at least 1 industry payment was 61.4% (715 of 1164), whereas the proportion of their male counterparts was 70.4% (2337 of 3319). Across all payment types, female radiation oncologists received a smaller percentage of total industry funding than the percentage of female physicians represented in each category. The median payment value was smaller for female radiation oncologists in consulting (-$1000; 95% CI, -$1966.67 to $100.63; P = .005) and honoraria (-$500; 95% CI, -$1071.43 to $0; P = .007). This trend was also observed in research payments, but was not statistically significant (-$135.02; 95% CI, -$476.93 to $6.88; P = .08). Of the $1 347 509 royalty or license payments made to 72 physicians, none was for female radiation oncologists. Conclusions and Relevance: Distribution of industry payments appears to show sex disparity in industry relationships among radiation oncologists; this observation warrants further investigation to determine the underlying reasons and provide avenues for increased parity.


Assuntos
Indústrias/economia , Médicas/economia , Radio-Oncologistas/economia , Remuneração , Centers for Medicare and Medicaid Services, U.S. , Estudos Transversais , Organização do Financiamento , Humanos , Indústrias/estatística & dados numéricos , Licenciamento/economia , Médicas/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Encaminhamento e Consulta/economia , Apoio à Pesquisa como Assunto/economia , Estudos Retrospectivos , Distribuição por Sexo , Estados Unidos
16.
BMC Med Educ ; 19(1): 33, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683085

RESUMO

BACKGROUND: Worldwide, many undergraduate general practice curricula include community-based courses at general practitioners' (GPs') offices. Usually the academic general practice departments collaborate with networks of affiliated teaching practices. To successfully master the challenge of network development and extension, more information is needed about GPs' willingness to be involved in different teaching formats, important influencing factors, incentives, barriers, and the need for financial compensation. METHODS: In this cross-sectional study a questionnaire survey was conducted among all GPs working in Leipzig and environs (German postal code area 04). In addition to descriptive statistics, group comparisons and logistic regression were performed to reveal differences between GPs with and without an interest in teaching. RESULTS: Response rate was 45.3% with 339 analyzable questionnaires. The average age was 52.0 years and 58.4% were women. Sixty-two participants stated that they were already involved in teaching undergraduates. Altogether 60.1% of all GPs and 53.5% among those who didn't teach yet were basically interested in being involved in undergraduate education. The interested GPs could imagine devoting on average 6.9 h per month to teaching activities. GPs interested in teaching were on average younger, were more actively involved in continuing education and professional associations, and more frequently had pre-existing teaching experiences. The willingness to teach differed substantially among teaching formats. GPs were more willing to teach at their own practices rather than at university venues and they preferred skills-oriented content. Comprehensive organization on the part of the university including long-term scheduling and available teaching materials was rated as most important to increase the attractiveness of teaching. Time restraints and decreased productivity were rated as the most important barriers. Interested GPs appreciated financial compensation, particularly for teaching at university venues, and demanded amounts of money corresponding to German GPs' hourly income. CONCLUSIONS: The GPs' interest in undergraduate teaching is generally high indicating a substantial pool of potential preceptors. Recruitment strategies should consider the collaboration with institutions involved in residency and continuing education as well as with professional associations. Comprehensive organization by the responsible department should be promoted and time restraints and decreased productivity should be overtly addressed and financially compensated.


Assuntos
Atitude do Pessoal de Saúde , Educação de Graduação em Medicina/economia , Medicina Geral/educação , Clínicos Gerais , Remuneração , Ensino , Adulto , Estudos Transversais , Currículo , Feminino , Medicina Geral/economia , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Preceptoria/economia , Inquéritos e Questionários
17.
J Am Pharm Assoc (2003) ; 59(1): 89-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30195440

RESUMO

OBJECTIVES: Recognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services, and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services. DATA SOURCES: Systematic searches for relevant articles published from January 2013 to February 2018 across Pubmed (Medline), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus, and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed. STUDY SELECTION: Programs were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing. DATA EXTRACTION: Descriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial, or regional level, as applicable), payer, service description, patient eligibility criteria, and fee structure. RESULTS: Over the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations, and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service. CONCLUSION: Although funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility, and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation.


Assuntos
Planos de Pagamento por Serviço Prestado/economia , Assistência ao Paciente/economia , Assistência Farmacêutica/economia , Farmacêuticos/economia , Remuneração , Humanos , Internacionalidade
19.
Acad Radiol ; 26(1): 86-92, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29958777

RESUMO

RATIONALE AND OBJECTIVES: The characterization of payments made to physicians by pharmaceutical companies, device manufacturers, and group purchasing organizations is crucial for assessing potential conflicts of interest and their impact on practice patterns. This study examines the compensation received by general radiologists (GR) in the United States, as well as radiologists in the following five subspecialties: body imaging, neuroradiology, pediatric radiology, nuclear radiology and radiological physics, and vascular and interventional radiology. MATERIALS AND METHODS: Data were extracted from the Open Payments database for radiology subspecialists in the United States who received installments in calendar year 2015 from pharmaceutical and device manufacturing companies. RESULTS: In 2015, a total of $43,685,052 was paid in 65,507 payments (mean $667/payment; median $32/payment) to radiologists, including 9826 GR, 362 body imaging radiologists, 479 neuroradiologists, 127 pediatric radiologists, 175 physicians in nuclear radiology and radiological physics, and 1584 vascular and interventional radiologists. Payments were unequally distributed across these six major subspecialties of radiology (p < 0.01), with GR receiving the largest number of total payments (44,695), and neuroradiologists receiving significantly higher median payments than any other subspecialty ($80 vs $32 for all radiologists; p < 0.01). Medtronic Neurovascular was the single largest payer to all radiologists combined. CONCLUSION: Commercial entities make substantial payments to radiologists, with a significant variation in payments made to the different radiology subspecialties. While the largest number of total payments was made to GGR, the highest median payments were made to neuroradiologists, and significant dispersion in these payments was seen across different geographic regions. The impact of these payments on practice patterns remains to be elucidated.


Assuntos
Indústria Farmacêutica/economia , Indústria Manufatureira/economia , Radiologia/economia , Bases de Dados Factuais , Indústria Farmacêutica/legislação & jurisprudência , Equipamentos e Provisões , Humanos , Indústria Manufatureira/legislação & jurisprudência , Medicina Nuclear/economia , Medicina Nuclear/estatística & dados numéricos , Radiologia/estatística & dados numéricos , Radiologia Intervencionista/economia , Radiologia Intervencionista/estatística & dados numéricos , Remuneração , Estados Unidos
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