Long-Term Care Pharmacy Market Shares and Differences in Skilled Nursing Facilities Served.

Medications and pharmacy services are critical to post-acute care (PAC) in skilled nursing facilities (SNFs), yet little is known about the long-term care (LTC) pharmacies that provide them. We estimated the market shares of LTC pharmacies and how SNFs differed between pharmacies. This cross-sectional study used data from SNFs that provided PAC services in Rhode Island (RI) in 2019. We applied the parametric g-formula to compare SNF pharmacy-related deficiencies and medication use measures between LTC pharmacies while standardizing for SNF membership in a chain and number of beds. Among 75 SNFs, 68 (91%) were served by either Omnicare (n = 32, 43%) or PharMerica (n = 36, 48%), and 7 (9%) by other LTC pharmacies. After covariate adjustment, PharMerica SNFs had the lowest prevalences of any pharmacy-related deficiency (PharMerica, 63.2%; Omnicare, 80.2%; other LTC pharmacy, 69.1%) and antianxiety medication use (PharMerica, 9.7%; Omnicare, 13.6%; other LTC pharmacy, 13.5%), but estimates were imprecise. The RI market is highly concentrated between LTC pharmacies. If similarly high LTC pharmacy market concentration exists nationally, there is enormous promise for efficiently delivering interventions to improve medication management in SNFs. However, it may also present a risk of harm if policies do not maintain sufficient competition and innovation is stifled.

Little is known about long-term care pharmacies serving skilled nursing facilitiesThese pharmacies may have a strong influence on quality of care and outcomesTwo pharmacies dominate 91% of the Rhode Island skilled nursing facility marketSkilled beds, pharmacy deficiencies, and medication use may differ by pharmacyPharmacy market concentration creates opportunities for both big benefits and harms.

Exploring Customer Journeys in the Context of Dentistry: A Case Study.

This case study aims to explore how customer journey concepts can apply to a hypothetical scenario, centring on a patient (customer persona) within the dentistry arena, and with a particular focus on special care dentistry. As an educational exercise, this paper may inform dental and allied professionals on how aspects of the customer journey notion may be embedded into their own practices, so that patient-centricity might be better optimised. The hypothetical scenario considers the organisational context, customer persona, contemporary customer purchase decision-making models, and marketing approaches. These components are used to create a customer journey map to help visualise and identify the varying customer-business interactions. The customer journey, focussing on the awareness, initial consideration, active evaluation, pre-purchase, purchase and post-purchase stages, is then conceptually analysed. The analyses reveal that there are areas of friction, attributable to numerous factors. The case study recommends that by introducing digitalisation and omnichannel marketing, alongside existing internally generated and multi-channel marketing approaches, considerable improvements may be achievable. As the patient technology landscape becomes more digital and dental organisations face fiercer competition, dental care providers relying on traditional marketing approaches may well need to adapt and introduce innovative, yet cost-effective digitalisation and omnichannel marketing approaches. Nevertheless, dental care providers, and dental and allied professionals must uphold an underlying duty of care, ensuring that all practises are legal, decent, honest, truthful, and above all ethical.

How to establish infrastructures to achieve more efficient regenerative medicine?

The field of regenerative medicine (RM) as an innovative technology has the ability to affect the healthcare system. It develops a variety of techniques through stem cell biology, genetics, bioengineering, biomaterial science, and tissue engineering to replace or restore the role of lost, disabled, or aging cells in the human body. However, the field's proficiency has still been underwhelming at the clinical trial level. This could be due to the innovation of such technologies, as well as their incredible nature. Therefore, managing the infrastructure framework for the safe and efficient application of the aforementioned field of science would help in the process of progress. In this context, the current review focuses on how to establish infrastructures for more effective RM.

Disparities in industry funding among Colorectal Surgeons: a cross-sectional study.

BACKGROUND: Health Industry and physician collaboration generates innovation. Colorectal Surgeon (CRS) selection to collaborate might not be random. We aim to identify CRS personal and professional characteristics that facilitate collaboration with the Industry. METHOD: Cross-sectional study of Industry payments to CRS (2014-2018) using Open Payments Database from Centers for Medicare & Medicaid Services. Multivariable regression compared variables predicting payment amount including gender, years in practice, leadership positions, H-index, Twitter presence and geographic location. RESULTS: Surgeons who were male received 3.1 times the amount in Industry payments as compared to females (p = 0.014). Chairs and Division Chiefs received 2.7 times the amount in payments as compared to those without these leadership positions (p = 0.003). Surgeons with an H-index ≥ 8 received 2.2 times the amount in payments as compared to those with H-index < 8 (p = 0.001). Surgeons in practice for 12-19 and 20-30 years received 3 times and 4.4 times the amount in payments as compared to surgeons in practice for 1-11 years (p = 0.036 and p = 0.017, respectively). Surgeons in the South received 3.2 times and 2 times the amount in payments as compared to surgeons in the Northeast (p < 0.0005) and in the Midwest (p = 0.006). Surgeons with Twitter accounts received 1.7 times the amount in payments as compared to surgeons without Twitter (p = 0.036). Among Twitter users, those with 321-17,200 followers received 4.7 times and 9.5 times the amount in payments as compared to those with 0-15 and 16-79 followers, respectively (p = 0.008 and p = 0.009). CONCLUSION: Industry payments are more commonly addressed to male, senior surgeons in leadership tracks with strong social media outreach. With the increasing gender and racial variety in the CRS field, it is expected that collaborations between industry and surgeons will become more diverse and inclusive.

Marketing methods for electronic resources in medical libraries: a study on the application of the analytical hierarchy process.

Objective: Paired with the high cost of providing access to electronic resources in medical libraries, the inefficient use of these resources highlights the need for more efforts to promote these resources than ever before. In this study, electronic resource marketing methods were prioritized and the best strategies were determined using the analytical hierarchy process (AHP). Methods: Using an analytical survey of officials of medical libraries, the most common methods for marketing electronic resources in libraries were determined and divided into categories of strategies. Five important criteria for marketing strategies were also selected. Using the analytical hierarchy process, pairwise comparisons were performed between the alternatives (i.e., strategies), which were evaluated against the selected criteria. Data analysis was performed using Expert Choice 11 software. Results: A total of 44 electronic resource marketing methods were identified and categorized into 4 strategies. On average, 43.9% of these methods were used by the surveyed libraries. The analytical hierarchy process showed that simplicity was the most important criterion and that communication networks were the best electronic resource marketing strategy. Home/off-campus access, group training, library search stations, and marketing by individual librarians were the most preferred methods of marketing electronic resources. Conclusion: With the availability of a variety of different methods for marketing electronic resources, medical libraries must select strategies based on important criteria depending on the characteristics of the library, librarians, and users. Thus, the analytical hierarchy process can be an effective and practical solution to decision-making by mathematically prioritizing the selection of the best strategies from a set of alternatives based on differentially weighted criteria.

Medical advertising in social networks: awareness and medical school education / Publicidade médica em redes sociais: conhecimento e ensino na graduação de Medicina

ABSTRACT Objective: this study analyzed medicine students' knowledge regarding medical advertising on social media. Method: this is a cross-sectional study carried out between January and May 2022 with 179 medical students from public and private institutions from Curitiba - PR, using a structured questionnaire with nine problem situations on medical advertising. It was established as "sufficient" knowledge ≥70% of the problem-situations based on current professional codes and resolutions. Results: five questions had the highest percentage of correct answers resulting from the acquisition of knowledge from different sources. Most students did not learn about medical marketing in their undergraduate course (84.9%), having already shared patients' pictures on social media (89.9%), and fell the lack of discussions about medical advertising (96.6%). Conclusion: there is a need to direct undergraduate education towards the ethical use of advertising in order to better prepare them for professional practice.

RESUMO Objetivo: este estudo analisou o conhecimento dos estudantes de medicina sobre publicidade médica nas redes sociais. Método: Trata-se de estudo transversal realizado entre janeiro e maio de 2022 com 179 acadêmicos de medicina de instituição pública e privada em Curitiba - PR, por meio de questionário estruturado com nove situações-problemas sobre publicidade médica. Foi estabelecido como conhecimento "suficiente" o acerto ≥70% das situações-problemas com base nos códigos e resoluções profissionais vigentes. Resultados: cinco questões tiveram maior percentual de acerto decorrente da aquisição de conhecimento de diferentes fontes. A maioria dos estudantes não aprendeu sobre publicidade médica na graduação (84,9%), já divulgou imagens de pacientes pelas redes sociais (89,9%), e sente falta de mais discussões sobre publicidade (96,6%). Conclusão: há necessidade de direcionar o ensino da graduação para o uso ético da publicidade visando melhor preparo para o exercício profissional.

Aspectos envolvidos na contratação e manutenção do personal trainer: capitais em jogo / Aspects involved in hiring and maintaining a personal trainer: capitals at stake / Aspectos involucrados en la contratación y mantenimiento de un entrenador personal: capitales en juego

RESUMO Objetivou-se analisar os aspectos que influenciam na contratação e na manutenção do personal trainer, no ponto de vista dos clientes. Para a composição da pesquisa, usuários do serviço responderam questionários e entrevistas. Detectou-se que vários capitais estão em jogo, mas os clientes enfatizaram aspectos simbólicos relativos ao conhecimento, segurança e confiança no seu trabalho como diferenciais. Ao invés de valorizar o capital corporal, como apontado em outros estudos, a investigação observou a emergência do capital perfil como elemento de distinção.

ABSTRACT The objective was to analyze the aspects that influence the hiring and maintenance of the personal trainer, from the clients' point of view. For the composition of the survey, service users answered questionnaires and interviews. It was detected that several capitals are at stake, but clients emphasized symbolic aspects related to knowledge, security and confidence in their work as differentials. Instead of valuing body capital, as pointed out in other studies, the investigation observed the emergence of profile capital as an element of distinction.

RESUMEN El objetivo fue analizar los aspectos que influyen en la contratación y mantenimiento del entrenador personal, desde el punto de vista de los clientes. Para la composición de la encuesta, los usuarios del servicio respondieron cuestionarios y entrevistas. Se detectó que varios capitales están en juego, pero los clientes enfatizaron aspectos simbólicos relacionados con el conocimiento, la seguridad y la confianza en su trabajo como diferenciales. En lugar de valorar el capital corporal, como se señaló en otros estudios, la investigación observó el surgimiento del capital de perfil como elemento de distinción.

A entrada do capital estrangeiro no sistema de saúde no Brasil / The entry of foreign capital into the health system in Brazil / La entrada de capital extranjero en el sistema de salud en Brasil

O estudo descreve o histórico da legislação, analisa a trajetória e dimensiona o capital estrangeiro no sistema de saúde no Brasil. A Lei Orgânica da Saúde restringiu a participação do capital estrangeiro, legislações setoriais permitiram o posterior ingresso na assistência médica suplementar e, em 2015, uma nova lei promoveu a abertura irrestrita, inclusive em hospitais e serviços de saúde. O estudo analisou documentos, legislação e dados de bases secundárias públicas ou obtidos via Lei de Acesso à Informação. Foram considerados investimentos diretos e atos de fusões e aquisições no setor privado da saúde. Foram identificadas cinco fases: ordenamento inaugural, expansão regulada, restrição legal, liberação setorizada e abertura ampliada. De 2016 a 2020, ingressaram no país quase dez vezes mais recursos estrangeiros em serviços de saúde que no quinquênio anterior. Foram identificadas 13 empresas ou fundos, a maioria originária dos Estados Unidos. Normas que permitiram a abertura do capital estrangeiro foram antecedidas por lobbies empresariais e interações público-privadas que podem afetar a qualidade das políticas públicas e a integridade do processo legislativo. O capital aportado busca empresas já constituídas e mais rentáveis, em diversos segmentos de atividade. O ingresso ocorre em redes assistenciais privadas não universais, que atendem clientelas específicas, concentradas geograficamente. Conclui-se que o capital estrangeiro, elemento do processo de financeirização da saúde, se expressa como possível vetor da ampliação de desigualdades de acesso da população aos serviços de saúde e como um obstáculo adicional à consolidação do Sistema Único de Saúde.

The study describes the history of legislation, analyzes the trajectory and the amount of foreign capital in the Brazilian health system. The Organic Health Law restricted the participation of foreign capital; sectoral legislation, however, allowed its subsequent entry into supplementary medical care and, in 2015, a new law promoted unrestricted openness, including in hospitals and healthcare services. Our study analyzes documents, legislation, and data obtained from secondary public bases or via the Law on Access to Information. Direct investments and merger and acquisition acts in the private health sector were considered. Five phases were identified: inaugural planning, regulated expansion, legal restriction, sectorized release, and expanded opening. From 2016 to 2020, the amount of foreign resources entering the country's healthcare services was almost ten times more than the previous five-year period. Thirteen companies or funds were identified, most of them from the United States. Regulation allowing for the opening of foreign capital were preceded by business lobbies and public-private interactions that can affect the quality of public policies and the integrity of the legislative process. The invested capital seeks established and profitable companies in various segments of activity. Admission occurs in non-universal private care networks, which serve specific, geographically concentrated clientele. We conclude that foreign capital, an element of health financialization process, is expressed as a possible vector of the expansion of inequalities in the population's access to health services and as an additional obstacle to the consolidation of the Brazilian Unified National Health System.

Este estudio describe la historia de la legislación, analiza la trayectoria y dimensiona el capital extranjero en el sistema de salud en Brasil. La Ley Orgánica de Salud restringió la participación de capital extranjero, las legislaciones sectoriales permitieron el posterior ingreso a la asistencia médica complementaria y, en el 2015, una nueva ley promovió la apertura sin restricciones, incluso en hospitales y servicios de salud. El estudio analizó documentos, legislación y datos de bases públicas secundarias u obtenidos por medio de la Ley de Acceso a la Información. Se consideraron inversiones directas y actos de fusiones y adquisiciones en el sector privado de la salud. Se identificaron cinco etapas: ordenamiento inaugural, expansión regulada, restricción legal, liberación sectorizada y apertura ampliada. Del 2016 al 2020 ingresaron al país casi diez veces más recursos extranjeros en servicios de salud que en el quinquenio anterior. Se identificaron 13 empresas o fondos, la mayoría con origen en los EE.UU. Las reglas que permitieron la apertura al capital extranjero fueron precedidas por cabildeos empresariales e interacciones público-privadas que pueden afectar la calidad de las políticas públicas y la integridad del proceso legislativo. El capital aportado busca empresas ya consolidadas y más rentables, en diversos segmentos de actividad. El ingreso se da en redes asistenciales privadas no universales, que atienden a una clientela específica y geográficamente concentrada. Se concluye que el capital extranjero, elemento del proceso de financiarización de la salud, se expresa como un posible vector de la ampliación de desigualdades en el acceso de la población a los servicios de salud y como un obstáculo adicional para la consolidación del Sistema Único de Salud.

Navigating and Leveraging Social Media.

Social media has made a noteworthy impact in health care both in public health efforts as well as transforming how physicians connect and exchange ideas. Learning how to navigate and leverage social media across multiple platforms is becoming increasingly difficult with more platforms and features constantly being introduced. Different physicians working in the same field will have different purposes behind getting on social media, but each physician plays a different role within this social media ecosystem. This article aims to identify the common benefits of health care social media use as well as navigate the unfortunate pitfalls of social media use.

Comportamiento de compra ante el Covid-19: Estudio transversal latinoamericano desde un enfoque del marketing sanitario / Buying behavior in the time of Covid-19: Latin-American cross-sectional study from a healthcare marketing approach

Resumen Objetivo: Explorar los factores clave en los cambios de consumo en hombres y mujeres, en México, Ecuador y Colombia, por la situación de aislamiento causado por el COVID 19. Materiales y métodos: El modelo propuesto basado en Modelos Estructurales (SEM) se prueba a partir de una investigación cuantitativa, con una muestra de 2,065 consumidores en línea. Se realizaron los siguientes análisis estadísticos: CFA, invariancia de instrumentos de medición y análisis multigrupo con el software Smart Pls 3 y EQS 6.3. Resultados: El estudio revela que el tiempo, espacio y lugar en el proceso de consumo, es más visible en el comportamiento de compra con el distanciamiento social, la sana distancia y la restricción comercial provocada por la contingencia sanitaria. Además de ser una crisis sanitaria -y humanitaria-, la pandemia presenta graves consecuencias económicas en todo el mundo como desempleo, sistemas de salud colapsados, educación sobrepasada por tecnología, suministros interrumpidos, turismo internacional y doméstico suspendido, convivencia social coartada y una demanda decreciente en el consumo. Conclusiones: A pesar de ser países latinoamericanos, se hallaron diferencias en la prioridad de consumo y que ser hombre o mujer, en tiempos de crisis no cambian significativamente los comportamientos de compra y todos se han adaptado a compras en línea y a domicilio. El artículo presenta varias consideraciones sobre los elementos principales de los factores de consumo en tiempos de Covid-19, en un país individualista (Mx) y no encuentra diferencias sustanciales con los consumidores en un país colectivista (Co y Ec). Se hacen implicaciones prácticas para que las empresas adopten canales en línea y puedan crear estrategias de venta ante la pandemia endémica que se vive.

Abstract Objective: To explore the key factors in the changes in consumption in men and women, in Mexico, Ecuador and Colombia, due to the situation of isolation caused by COVID 19. Materials and methods: The proposed model based on Structural Models (SEM) is tested from quantitative research with a sample of 2,065 online consumers. The following statistical analyzes were performed: CFA, invariance of measurement instruments and multigroup analysis with Smart Pls 3 and EQS 6.3 software. Results: The study reveals that the time, space and place in the consumption process is more visible in the buying behavior with social distancing, healthy distance and commercial restriction caused by the health contingency. In addition to being a health -and humanitarian- crisis, the pandemic has serious economic consequences around the world such as unemployment, collapsed health systems, education overwhelmed by technology, interrupted supplies, suspended international and domestic tourism, restricted social coexistence and declining demand. in consumption. Conclusions: Despite being Latin American countries, differences were found in the priority of consumption and that being a man or a woman, in times of crisis, shopping behaviors do not change significantly and all have adapted to online and home purchases. The article presents several considerations on the main factors of consumption in times of Covid-19 in an individualistic country (Mx) and does not find substantial differences with consumers in a collectivist country (Co and Ec). Practical implications are made for companies to adopt online channels and create sales strategies in the face of the endemic pandemic that is being experienced.

Charcoal-based dentifrices and powders: analyses of product labels, Instagram engagement, and altmetrics

Abstract This study identified charcoal-based dentifrices and abrasive powders sold in Brazil and analyzed their label information. The products were searched in four online shopping platforms. The same products were searched on Instagram and their engagement metrics were investigated. Furthermore, a literature review of international publications assessing charcoal dentifrices and powders was conducted, and altmetrics were collected (Altmetric and PlumX). Thirty-six products were found with prices between $0.4-22 USD. Most frequent words in product description were sodium, stain, whitening, oil, xylitol, and coconut. Only 3 products contained fluoride. Bactericidal, antiviral, antifungal, and anti-inflammatory activities were indicated, in addition to non-scientific claims such as calming teeth or increasing oral immunity. In total, 72% of products had Instagram profiles, which generally showed low engagement rates (81%) and medium audience quality scores (65%). Twenty-two articles were found in the literature, from which 21 were in vitro studies. The single clinical study was sponsored by a charcoal product and had no control group. In total, 23% of studies showed positive results and 55% reported negative results for the charcoal products, which included no whitening ability, increased roughness, surface alterations, and lower demineralization prevention ability. Altmetric scores for the included articles varied from 0 to 55, with 40.9% of studies mentioned online. In conclusion, charcoal-based products are using marketing strategies on Instagram but their current engagement with the public is not high. Consumers are being exposed to charcoal products whose potential risks to health are still unknown.

Resumo Este estudo identificou dentifrícios e pós abrasivos de carvão vendidos no Brasil e analisou suas informações de rótulo. Os produtos foram pesquisados em quatro plataformas de compras online. Os mesmos produtos foram pesquisados no Instagram e métricas de engajamento dos perfis foram investigadas. Além disso, foi realizada uma revisão da literatura buscando publicações internacionais que avaliaram dentifrícios e pós de carvão; dados de altmetria foram coletados (Altmetric e PlumX). Foram encontrados 36 produtos com preços entre US$ 0,4-22. As palavras mais frequentes na descrição dos produtos foram sódio, mancha, clareamento, óleo, xilitol e coco. Apenas 3 produtos continham flúor. Foram indicadas atividades bactericidas, antivirais, antifúngicas e anti-inflamatórias, além de alegações não-científicas como acalmar dentes ou aumentar a imunidade oral. No total, 72% dos produtos tinham perfis no Instagram, que geralmente apresentavam baixas taxas de engajamento (81%) e média qualidade de audiência (65%). Vinte e dois artigos foram encontrados na literatura, dos quais 21 foram estudos in vitro. O único estudo clínico foi patrocinado por um produto de carvão e não tinha grupo controle. No total, 23% dos estudos apresentaram resultados positivos e 55% relataram resultados negativos para os produtos de carvão, que incluíram incapacidade de clareamento, aumento da rugosidade, alterações superficiais e menor capacidade de prevenção da desmineralização do esmalte. A altmetria dos artigos incluídos variou de 0 a 55, com 40,9% dos estudos sendo mencionados online. Em conclusão, os produtos à base de carvão estão usando estratégias de marketing no Instagram, mas seu engajamento atual com o público não é alto. Consumidores estão sendo expostos a produtos de carvão cujos potenciais riscos à saúde ainda são desconhecidos

Publicidade médica em tempos de medicina em rede / Medical advertising in times of network medicine / Publicidad médica en tiempos de la medicina en red

Resumo Este artigo objetiva avaliar o conhecimento de médicos sobre marketing de serviços de saúde. Trata-se de estudo prospectivo transversal com formulário autoaplicado que abarcou dados sociodemográficos, conhecimentos acerca da publicidade e opinião sobre o tema. Os resultados apontam que 60,7% e 67,5% dos médicos formados em instituições privadas e públicas, respectivamente, afirmam não ter tido contato com o tema durante a graduação, 62,9% declararam já ter enfrentado dificuldade por falta de conhecimento no assunto, e 94,5% sentiram necessidade de se atualizar depois de responder ao questionário. Os médicos participantes mostraram bom conhecimento, com dificuldades específicas sobre a divulgação de títulos, produtos e informações de alerta à população. Conclui-se ser necessário abordar o assunto no currículo formal durante a graduação e elaborar medidas educativas mais objetivas.

Abstract This article aims to evaluate doctors' knowledge on medical marketing through a prospective cross-sectional study, using a self-applied questionnaire that included sociodemographic data, knowledge and opinion on the topic. Results show that 60.7% and 67.5% of doctors graduated from private and public institutions, respectively, claimed having no contact with the subject during their undergraduate studies; 62.9% said they had faced difficulties due to lack of knowledge regarding the topic; and 94.5% felt the need to learn more after answering the questionnaire. The participants showed good knowledge, with specific difficulties regarding the dissemination of works, products and population-wide health warnings. In conclusion, undergraduate courses should include the topic in their formal curriculum and elaborate more objective educational measures.

Resumen Este artículo tiene como objetivo evaluar el conocimiento de los médicos sobre marketing de servicios de salud. Se trata de un estudio prospectivo transversal con un formulario autoaplicado que incluyó datos sociodemográficos, conocimientos sobre publicidad y opinión sobre el tema. Los resultados muestran que el 60,7% y el 67,5% de los médicos formados en instituciones privadas y públicas, respectivamente, afirman no haber tenido contacto con el tema durante su carrera; el 62,9% manifiestan que ya han enfrentado dificultades por desconocimiento del asunto; y el 94,5% sienten la necesidad de actualizarse después de responder el cuestionario. Los médicos participantes mostraron buen conocimiento, con dificultades específicas en la difusión de títulos, productos e información para alertar a la población. Se concluye que el currículo formal de la graduación debe abordar el asunto y desarrollar medidas educativas más objetivas.

A Strategic Imperative for Promoting Hospital Branding: Analysis of Outcome Indicators.

BACKGROUND: Optimizing the use of social media to promote hospital branding is important in the present digital era. In Taiwan, only 51.1% of hospitals have official Facebook fan pages. The numbers of likes for these hospitals are also relatively low. OBJECTIVE: Our objective was to establish a special branding team for social media operation, led by top administrators of our hospital. Here we present our strategic imperative for promoting hospital branding as well as an analysis of its effectiveness. METHODS: Led by top administrators, the branding team was formed by 11 divisions to create branding strategies. From 2016 to 2018, the team implemented action plans. All information unique to the hospital was posted on Facebook, as well as on the hospital's official website. To determine the plans' efficiencies, we obtained reference data from Google Analytics, and we compared Facebook Insights reports for 2016 with those for 2017 and 2018. RESULTS: One of the branding team's main missions was to establish branding strategies and to integrate segmental branding messages. In each quarter we regularly monitored a total of 52 action plan indicators, including those for process and outcome, and discussed the results at team meetings. We selected 4 main performance outcome indicators to reflect the effectiveness of the branding efforts. Compared with 2016, the numbers of likes posted on the Facebook fan page increased by 61.2% in 2017 and 116.2% in 2018. Similarly, visits to the hospital website increased by 4.8% in 2017 and 33.1% in 2018. Most Facebook fan page and website viewers were in 2 age groups: 25 to 34 years, and 35 to 44 years. Women constituted 60.42% (14,160/23,436) of Facebook fans and 59.39% (778,992/1,311,605) of website viewers. According to the Facebook Insights reports, the number of likes and post sharing both increased in 2017 and 2018, relative to 2016. Comment messages also increased from 2016 to 2018 (P=.02 for the trend). The most common theme of posts varied over time, from media reports in 2016, to innovative services in both 2017 and 2018. Likes for innovative services posts increased from 2016 through 2018 (P=.045 for the trend). By the end of 2018, we recorded 23,436 cumulative likes for posts, the highest number among medical centers in Taiwan. CONCLUSIONS: We achieved the largest number of Facebook fans among all medical centers in Taiwan. We would like to share our experience with other hospitals that might be interested in engaging in social media for future communications and interactions with their patients.

Determinants of patient satisfaction in outpatient musculoskeletal physiotherapy: a systematic, qualitative meta-summary, and meta-synthesis.

Purpose: To identify and synthesise patient-identified factors that influence satisfaction with outpatient musculoskeletal physiotherapy (O-MSK).Methods: A systematic, qualitative meta-summary and meta-synthesis was conducted by accessing six electronic databases: CINAHL, Embase, MEDLINE, Scopus, Web of Science, and Wiley Online Library, from inception to March 2017. Additional studies were identified by using a "berry-picking" method. Search limits were: primary studies; English language; and involving human subjects. Qualitative peer-reviewed articles describing patient satisfaction in O-MSK were eligible for inclusion. Two reviewers critically appraised eligible studies independently using the critical appraisal of skills programme tool for qualitative studies. Extracted verbatim data of included studies were synthesised using the meta-summary and meta-synthesis by using a purpose-designed form.Results: Eleven studies were included in the article. Factors influencing patient satisfaction were grouped into six broad themes: 1) clinical outcomes; 2) physiotherapist features; 3) patient features; 4) physiotherapist-patient relationship; 5) treatment features, and 6) healthcare setting features.Conclusions: These findings suggest that patient satisfaction in O-MSK is a multidimensional construct influenced by individual patient/provider, clinical, and contextual factors. Future reviews should include a synthesis of findings from both qualitative and quantitative studies to establish a fully comprehensive understanding of this complex health phenomenon.Implications for rehabilitationPatient satisfaction in outpatient musculoskeletal physiotherapy is affected by different factors, thus reflecting a multidimensional construct;Single determinants are not sufficient to affect patient satisfaction;Patient satisfaction is influenced individual patient/provider, clinical outcomes, and contextual factors;Further studies should be designed to investigate the relationships among these factors.

A Mobile Health Wallet for Pregnancy-Related Health Care in Madagascar: Mixed-Methods Study on Opportunities and Challenges.

BACKGROUND: Mobile savings and payment systems have been widely adopted to store money and pay for a variety of services, including health care. However, the possible implications of these technologies on financing and payment for maternal health care services-which commonly require large 1-time out-of-pocket payments-have not yet been systematically assessed in low-resource settings. OBJECTIVE: The aim of this study was to determine the structural, contextual, and experiential characteristics of a mobile phone-based savings and payment platform, the Mobile Health Wallet (MHW), for skilled health care during pregnancy among women in Madagascar. METHODS: We used a 2-stage cluster random sampling scheme to select a representative sample of women utilizing either routine antenatal (ANC) or routine postnatal care (PNC) in public sector health facilities in 2 of 8 urban and peri-urban districts of Antananarivo, Madagascar (Atsimondrano and Renivohitra districts). In a quantitative structured survey among 412 randomly selected women attending ANC or PNC, we identified saving habits, mobile phone use, media consumptions, and perception of an MHW with both savings and payment functions. To confirm and explain the quantitative results, we used qualitative data from 6 semistructured focus group discussions (24 participants in total) in the same population. RESULTS: 59.3% (243/410, 95% CI 54.5-64.1) saved toward the expected costs of delivery and, out of those, 64.4% (159/247, 95% CI 58.6-70.2) used household cash savings for this purpose. A total of 80.3% (331/412, 95% CI 76.5-84.1) had access to a personal or family phone and 35.7% (147/412, 95% CI 31.1-40.3) previously used Mobile Money services. Access to skilled health care during pregnancy was primarily limited because of financial obstacles such as saving difficulties or unpredictability of costs. Another key barrier was the lack of information about health benefits or availability of services. The general concept of an MHW for saving toward and payment of pregnancy-related care, including the restriction of payments, was perceived as beneficial and practicable by the majority of participants. In the discussions, several themes pointed to opportunities for ensuring the success of an MHW through design features: (1) intuitive technical ease of use, (2) clear communication and information about benefits and restrictions, and (3) availability of personal customer support. CONCLUSIONS: Financial obstacles are a major cause of limited access to skilled maternal health care in Madagascar. An MHW for skilled health care during pregnancy was perceived as a useful and desirable tool to reduce financial barriers among women in urban Madagascar. The design of this tool and the communication strategy will likely be the key to success. Particularly important dimensions of design include technical user friendliness and accessible and personal customer service.

Fatores determinantes na escolha de um cirurgião plástico / Determining factors in choosing a plastic surgeon

Introdução: Esta pesquisa tem como objetivo entender os fatores que determinam a escolha de um cirurgião plástico, na visão dos pacientes. É um projeto piloto que deve ser ampliado e aprofundado em outros estudos. Método: Foi idealizada uma pesquisa com 22 perguntas de múltipla escolha na forma de questionário. O tempo médio de resposta era de 8 minutos. As perguntas abordavam vários aspectos como a indicação/formação/titulação do cirurgião, percepção da primeira consulta e do consultório. Não havia possibilidade de identificação da paciente ou do cirurgião. O anonimato era garantido. Resultados: O índice de resposta foi de 86,66%. A maioria (92,22%) era do sexo feminino, com idade média de 35 anos. A maior parte tinha ensino médio e superior completos, com ganho familiar médio mensal de R$ 2 a 10 mil. Quase 40% não sabiam da titulação do cirurgião escolhido e 33,7% não sabia o tempo de formação do mesmo. A maioria (81,6%) acredita ter pago um valor na média pela sua cirurgia e metade não pesquisou a apresentação online do cirurgião. A maioria (67%) não tinha feito nenhuma cirurgia plástica previamente. Foi apresentada uma lista de 10 itens em ordem decrescente de importância. Conclusões: Os fatores determinantes para a escolha do cirurgião plástico nesta amostra, em ordem decrescente são: 1-Indicação, 2-Titulação e 3-Primeira consulta. Preço não está entre os primeiros atributos e apresentação online foi um dos últimos itens citados. Uma parte significativa dos pesquisados não conhece a titulação e nem o tempo de formação do seu cirurgião.

Introduction: This study aims to understand the factors that determine the choice of a plastic surgeon from the patient's perspective. This is a pilot project, which should be broadened and deepened by other studies. Method: A survey was devised in the form of a questionnaire with 22 multiple choice questions. The average response time was 8 minutes. The questions addressed various aspects, such as the recommendation, training, and accreditation of the surgeon; perception of the first consultation; and the clinic. There was no possibility of identifying the patient or surgeon; hence, anonymity was guaranteed. Results: The response rate was 86.66%. The majority (92.22%) of the respondents were female, with a mean age of 35 years. Most had completed secondary and higher education, with an average monthly family income of R$ 2,000 to 10,000. Almost 40% did not know the accreditation of the surgeon chosen and 33.7% did not know the length of training the surgeon had undergone. The majority (81.6%) believed they had paid an average amount for their surgery and half did not research the surgeon's online profile. The majority (67%) had not undergone any previous plastic surgery. A list of 10 items in descending order of importance was presented. Conclusions: The determining factors for the choice of the plastic surgeon in this sample, in descending order were: 1) Recommendation, 2) Accreditation, and 3) First consultation. Price was not the most important factor and online presence was one of the last items cited. A significant proportion of respondents did not know either the accreditation level or the length of training of their surgeon.

Resource-based theory of competitive advantage - a framework for pharmacy practice innovation research.

A growing body of research demonstrates the effectiveness of evidence-based pharmacy practice, but too many practice innovations fail to survive past the initial implementation and study phase. This paper presents the resource-based theory of competitive advantage as a framework for describing, understanding, and predicting the adoption and dissemination pharmacy service innovations into routine practice. The theory argues that the sustainability of any business innovation (e.g., pharmacy service) is based upon (1) the internal resources of the firm offering it, (2) the firm's capabilities in using those resources, (3) the competitive advantage to the firm of its resources and capabilities, (4) the attractiveness of the market in which it competes, and (5) the innovation's contribution to financial performance of the firm. This paper argues that the resource-based theory of competitive advantage provides a foundation for comparing findings from different research frameworks and studies relating to innovations in services, service processes, and service business models. The paper also poses a number of research questions related to the theory that can be used to further the literature about pharmacy practice innovations. Finally, it makes a case that competition is a fundamental aspect of pharmacy practice and the resource-based theory of competitive advantage can serve as a general theory for studying innovations in pharmacy practice and in the social and administrative sciences.

Gabapentin for Off-Label Use: Evidence-Based or Cause for Concern?

Gabapentin is widely used in the United States for a number of off-label indications, often as an alternative to opioid therapy. Increasing evidence has emerged suggesting that gabapentin may not be as benign as once thought and may be associated with substance abuse in concert with opioids. With concerns for safety mounting, it is prudent to examine the efficacy of gabapentin across its many uses to understand the risk-benefit balance. Reviews on off-label indications such as migraine, fibromyalgia, mental illness, and substance dependence have found modest to no effect on relevant clinical outcomes. This high-quality evidence has often been overshadowed by uncontrolled studies and limited case reports. Furthermore, the involvement of gabapentin in questionable marketing schemes further calls its use into question. Overall, clinicians should exercise rigorous appraisal of the available evidence for a given indication, and researchers should conduct larger, higher-quality studies to better assess the efficacy of gabapentin for many of its off-label uses.

[Market access agreements: Definition and features. Could MAA be defined as a solution for immunotherapy funding by French health system?] / Les contrats d'accès au marché : définition et caractéristiques. Une solution pour garantir la prise en charge de l'immunothérapie par le système de santé français ?

Over the last few years, many therapeutic innovations have been approved and marketed in France, within a strained financial setting. Legal dispositions allowed manufacturers (LEEM - les enterprises du medicament) and the economic committee for health products (CEPS) to contract various confidential market access agreements to contain health product expenses. The purposes of this article are to define and describe these different existing market access agreements and to open discussion on their applicability to the problematic of immune-oncology drugs financing. Financial agreements, which led to major savings (discounts refunded to the public payer), have not responded completely to the therapeutic innovations financing problems. Performance agreements (funding based on real-life data and effectiveness of the drug) constitute a hope for health products financing, but major methodological challenges for their use in routine restrict them to rare cases only today. Even though several financial agreements could partly respond to this problematic, use of performance agreements could really constitute an interesting track to tackle this issue.

Identifying Consumers Who Search for Long-Term Care on the Web: Latent Class Analysis.

BACKGROUND: Because the internet has become a primary means of communication in the long-term care (LTC) and health care industry, an elevated understanding of market segmentation among LTC consumers is an indispensable step to responding to the informational needs of consumers. OBJECTIVE: This exploratory study was designed to identify underlying market segments of the LTC consumers who seek Web-based information. METHODS: Data on US adult internet users (n=2018) were derived from 2010 Pew Internet and America Life Project. Latent class analysis was employed to identify underlying market segments of LTC Web-based information seekers. RESULTS: Web-based LTC information seekers were classified into the following 2 subgroups: heavy and light Web-based information seekers. Overall, 1 in 4 heavy Web-based information seekers used the internet for LTC information, whereas only 2% of the light information seekers did so. The heavy information seekers were also significantly more likely than light users to search the internet for all other health information, such as a specific disease and treatment and medical facilities. The heavy Web-based information seekers were more likely to be younger, female, highly educated, chronic disease patients, caregivers, and frequent internet users in general than the light Web-based information seekers. CONCLUSIONS: To effectively communicate with their consumers, providers who target Web-based LTC information seekers can more carefully align their informational offerings with the specific needs of each subsegment of LTC markets.