Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study

Background: In Germany over-the-counter medications (OTC) - which since 2004 are no longer subject to binding prices - can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications. Objective: The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient's approach (symptom-based versus medication-based request) in determining the outcome of these aspects. Methods: A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids. Results: In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an 'adequate intake of fluids' in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified - for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53. Conclusions: Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated

No disponible

Dispensación de benzodiacepinas y análogos en farmacias comunitarias de Valladolid / Dispensation of benzodiazepines and analogues in community pharmacies in Valladolid

Introducción: Las benzodiacepinas (BZD) son fármacos de consumo creciente, que se utilizan muy frecuentemente para los trastornos de ansiedad y del sueño, así como relajantes musculares. Muchos pacientes las usan de forma crónica a pesar de estar desaconsejadas y, en algunas ocasiones, de manera inadecuada, en especial la población anciana. Objetivos: Investigar las principales características de los usuarios, las BZD prescritas, si se tiene conocimiento y se hace un buen uso de ellas, las reacciones adversas, las posibles interacciones farmacológicas con la medicación y otros problemas relacionados con los medicamentos. Material y métodos: Se llevó a cabo un estudio transversal en 2 farmacias comunitarias de Valladolid desde septiembre de 2012 hasta febrero de 2013. Se utilizó un cuestionario cerrado y administrado por el farmacéutico. Se incluyeron todos los pacientes mayores de 16 años que solicitaron BZD prescritas por el médico. Resultados: En total, 104 pacientes consintieron ser entrevistados. La mayor parte utilizaba las BZD más tiempo del aconsejado. El 63,5% de los pacientes experimentó, al menos, una reacción adversa (dependencia, sedación, somnolencia, pérdida de memoria, etc.). El 13,2% de los usuarios mayores de 65 años estaba tomando dosis mayores de las recomendadas en la fi cha técnica, y el 27,7% de éstos utilizaba BZD de vida media larga. Conclusiones: Este estudio muestra un inadecuado uso de las BZD por parte de la población, en especial los ancianos. El farmacéutico comunitario junto con el médico desempeñan un papel clave en la mejora del uso de las BZD por parte de la población (AU)

Background: Benzodiazepines (BZD) are drugs of growing consumption, which are very often used for anxiety disorders, sleep and relaxing muscle. Many patients use them chronically despite being discouraged and sometimes misused, particularly in the elderly population. Aims: To investigate the main characteristics of the users, prescribed BZD, knowledge and if they make good use of them, adverse reactions, possible drug interactions with medication and other drug-related problems. Material and methods: A cross-sectional study in two community pharmacies in Valladolid was conducted during the months of September of 2012 through February of 2013. We used a closed questionnaire administered by the pharmacist. We included all patients older than sixteen years that requested BZD prescribed by the doctor. Results: In total, 104 patients consented to be interviewed. Most of the users took BZD longer than the recommended time. The 63.5% of the patients experienced at least one adverse reaction (dependence, sedation, sleepiness, loss of memory, etc.). The 13.2% of users over the age of 65 was taking doses higher than those recommended in the technical sheet and 27.7% of these used long half-life BZD. Conclusions: This study shows the inadequate use of BZD by the population, especially in the elderly population. The community pharmacist and the doctor play a key role in the improvement of the use of BZD by the population (AU)

Behind-the-counter statins: a silver bullet for reducing costs and increasing access?

OBJECTIVE: To examine how the 2004 introduction of behind-the-counter (BTC) simvastatin in the United Kingdom affected utilization, prices, and expenditures. DATA SOURCES/STUDY SETTING: Secondary data on simvastatin utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries. STUDY DESIGN: We used a difference-in-differences approach to estimate how the introduction of BTC simvastatin affected utilization, prices, and expenditures. This approach compares outcomes in the United Kingdom before and after the introduction of BTC simvastatin, using outcomes in countries where the drug remained prescription only to control for possible confounders. DATA COLLECTION/EXTRACTION METHODS: Data on simvastain utilization, prices, and expenditures between 1997 and 2007 in the United Kingdom and four other countries were obtained from an outside vendor. PRINCIPAL FINDINGS: The introduction of BTC simvastatin in the United Kingdom led to a significant increase in utilization of simvastatin and a significant decline in expenditures for simvastatin purchases. Our results are robust to alternate model specifications. CONCLUSIONS: Behind-the-counter statins have the potential to simultaneously increase use of statins and lower expenditures.