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4.
BMC Health Serv Res ; 19(1): 576, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419977

RESUMO

BACKGROUND: Affordability and availability of quality medicines to all its citizens has been a key priority area for South Africa since democracy in 1994. In order to introduce transparency in the private market the government introduced the Single Exit Price (SEP) for medicines in 2004, for all prescription medicines, comprising of a fixed ex-factory price with a logistics fee component (and value added tax) for medicines sold to all purchasers other than the State. This is complemented with a provision for an annual regulated maximum percentage increase. The study evaluates the impact of the SEP on a basket of originator medicines, in terms of costs, immediate price reductions and projected price reductions. METHOD: This is an analytical, quantitative study. A basket of medicines was selected, based on the WHO/HAI list, and adapted to include registered medicines in South Africa. Prices of 50 originator medicines were assessed from 1999 to 2014 in terms of the single exit price and the changes in prices in accordance with legislation using a time series analysis methodology. RESULTS: Of the 50 originator medicines investigated 35 showed a statistically significant change in level. For the Global Core list, the percentage change ranged from 2.45-39.12% (mean = 19.87%, SD = 10.62%, IQR = 10.2%). The range for the Regional Core list was 1.77-42.17% (mean = 23.38%, SD = 12.43%, IQR = 15.65%). The Supplementary list was 11.68-55.86% (mean = 22.97%, SD = 16.26%, IQR = 17.34). This study indicates that the SEP regulation had an impact on medicine pricing in South Africa in both the short and long term. Most medicines investigated showed a smaller yearly increase in price compared to before regulations due to the controlled pricing environment introduced by Government. CONCLUSION: This study provides evidence of the impact of medicine pricing intervention from a middle-income country, and other developing countries looking at introducing medicine price controls can draw useful lessons.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Medicamentos sob Prescrição/economia , Comércio/economia , Custos e Análise de Custo , Estudos de Avaliação como Assunto , Humanos , Análise de Séries Temporais Interrompida , Medicamentos sob Prescrição/provisão & distribução , África do Sul/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-31450782

RESUMO

Despite the abundant literature on the burden of rising costs of prescription medications, there is limited research to explore how these costs affect people and the decisions they are forced to make within the context of disability. In this qualitative study we explored strategies adopted, factors influencing, and the impact of some of these strategies to manage the burden of medication cost among persons with disabilities. We interviewed 12 adults with spinal cord injuries living in Canada, using a general inductive approach to analyze the data. We found that before cutting back on medications due to costs, participants generally tried and sought help from the government, employers, and/or their prescribers to improve their drug coverage. The key factors that participants considered while making decisions on the strategies included the cost and perceived importance of medications, their financial status, other competing needs, and their relationship with the prescribers. While some of their efforts were successful, many participants were still not able to obtain their medications as prescribed. In those cases, patients resorted to rationing strategies such as cutting back on medications, other essential needs, or selling assets. These strategies had serious implications on their health, healthcare utilization, and quality of life.


Assuntos
Pessoas com Deficiência/psicologia , Custos de Medicamentos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Medicamentos sob Prescrição/economia , Canadá/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Medicamentos sob Prescrição/provisão & distribução , Pesquisa Qualitativa , Qualidade de Vida
6.
PLoS One ; 14(7): e0214630, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356615

RESUMO

INTRODUCTION: Non-medical prescribing was introduced into the United Kingdom (UK) to improve patient care, through extending healthcare professionals' roles. More recent government health service policy focuses on the increased demand and the need for efficiency. This systematic policy review aimed to describe any changes in government policy position and the role that non-medical prescribing plays in healthcare provision. METHOD: The systematic policy review included policy and consultation documents that describe independent non-medical prescribing. A pre-defined protocol was registered with PROSPERO (CRD42015019786). Professional body websites, other relevant websites and the following databases were searched to identify relevant documents: HMIC, Lexis Nexis, UK Government Web Archive, UKOP, UK Parliamentary Papers and Web of Science. Documents published between 2006 and February 2018 were included. RESULTS AND DISCUSSION: Following exclusions, 45 documents were selected for review; 23 relating to policy or strategy and 22 to consultations. Of the former, 13/23 were published 2006-2010 and the remainder since 2013. Two main themes were identified: chronological aspects and healthcare provision. In the former, a publication gap for policy documents resulted from a change in government and associated major healthcare service reorganisation. In the later, the role of non-medical prescribing was found to have evolved to support efficient service delivery, and cost reduction. For many professions, prescribing appears embedded into practice; however, the pharmacy profession continues to produce policy documents, suggesting that prescribing is not yet perceived as normal practice. CONCLUSION: Prescribing appears to be more easily adopted into practice where it can form part of the overall care of the patient. Where new roles are required to be established, then prescribing takes longer to be universally adopted. While this review concerns policy and practice in the UK, the aspect of role adoption has wider potential implications.


Assuntos
Prescrições de Medicamentos , Política de Saúde , Enfermeiras e Enfermeiros , Farmacêuticos , Bases de Dados Factuais , Política de Saúde/legislação & jurisprudência , Humanos , Internet , Enfermeiras e Enfermeiros/legislação & jurisprudência , Farmacêuticos/legislação & jurisprudência , Medicamentos sob Prescrição/provisão & distribução , Medicina Estatal/legislação & jurisprudência , Reino Unido
7.
Int J Clin Pharm ; 41(4): 825-830, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172411

RESUMO

The good availability of medicines and medicine shortages have become global issues during recent years. Medicine shortages are often affected by universal determinants, but the availability of medicines is also depending on national characteristics. This commentary aims to discuss the issue of the availability of medicines and medicine shortages in outpatient care in Finland, taking in consideration both national characteristics and global determinants that effect on the availability of medicines in other countries but Finland also. In this commentary, a regulatory approach is applied.


Assuntos
Assistência Ambulatorial , Controle de Medicamentos e Entorpecentes , Medicamentos sob Prescrição/provisão & distribução , Finlândia , Humanos , Internacionalidade
8.
JAMA Netw Open ; 2(6): e195388, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31173125

RESUMO

Importance: Despite the increasingly important role of pharmacies in the implementation of naloxone access laws, there is limited information on the impact of such laws at the local level. Objective: To evaluate the availability (with or without a prescription) and cost of naloxone nasal spray at pharmacies in Philadelphia, Pennsylvania, following a statewide standing order enacted in Pennsylvania in August 2015 to allow pharmacies to dispense naloxone without a prescription. Design, Setting, and Participants: A survey study was conducted by telephone of all pharmacies in Philadelphia between February and August 2017. Pharmacies were geocoded and linked with the American Community Survey (2011-2015) to obtain information on the demographic characteristics of census tracts and the Medical Examiner's Office of the Philadelphia Department of Public Health to derive information on the number of opioid overdose deaths per 100 000 people for each planning district. Data were analyzed from March 2018 to February 2019. Main Outcomes and Measures: Availability and out-of-pocket cost of naloxone nasal spray (with or without a prescription) at Philadelphia pharmacies overall and by pharmacy and neighborhood characteristics. Results: Of 454 eligible pharmacies, 418 were surveyed (92.1% response rate). One in 3 pharmacies (34.2%) had naloxone nasal spray in stock; of these, 61.5% indicated it was available without a prescription. There were significant differences in the availability of naloxone by pharmacy type and neighborhood characteristics. Naloxone was both more likely to be in stock (45.9% vs 27.8%; difference, 18.0%; 95% CI, 8.3%-27.8%; P < .001) and available without a prescription (80.6% vs 42.2%; difference, 38.4%; 95% CI, 23.0%-53.8%; P < .001) in chain stores than in independent stores. Naloxone was also less likely to be available in planning districts with very elevated rates of opioid overdose death (≥50 per 100 000 people) compared with those with lower rates (31.1% vs 38.5%). The median (interquartile range) out-of-pocket cost among pharmacies offering naloxone without a prescription was $145 ($119-$150); costs were greatest in independent pharmacies and planning districts with elevated rates of opioid overdose death. Conclusions and Relevance: Despite the implementation of a statewide standing order in Pennsylvania more than 3 years prior to this study, only one-third of Philadelphia pharmacies carried naloxone nasal spray and many also required a physician's prescription. Efforts to strengthen the implementation of naloxone access laws and better ensure naloxone supply at local pharmacies are warranted, especially in localities with the highest rates of overdose death.


Assuntos
Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Farmácias/estatística & dados numéricos , Administração por Inalação , Honorários Farmacêuticos , Gastos em Saúde/estatística & dados numéricos , Humanos , Naloxona/economia , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/economia , Antagonistas de Entorpecentes/provisão & distribução , Sprays Nasais , Medicamentos sem Prescrição/administração & dosagem , Medicamentos sem Prescrição/economia , Medicamentos sem Prescrição/provisão & distribução , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Farmácias/economia , Philadelphia , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribução
9.
Artigo em Inglês | MEDLINE | ID: mdl-31167350

RESUMO

The general objective of this study was to identify and prioritize the critical success factors required for the adoption of a system to create value for pharmaceutical supply chain stakeholders, and the pharmaceutical supply network as a whole, by using a multi-perspective framework that combines elements of the technology-organization-environment (TOE) contexts for enterprises. The methodology is based on a literature review and expert interviews following the analytic hierarchy process (AHP). This paper identifies and prioritizes 18 critical success factors from three categories: technological, organizational, and environmental. From a practical point of view, this research contributes to the literature by providing expert insight on the topic of drug traceability, especially in terms of how possible values can be captured by companies.


Assuntos
Controle de Medicamentos e Entorpecentes/organização & administração , Medicamentos sob Prescrição/provisão & distribução , Humanos
10.
NCHS Data Brief ; (334): 1-8, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31112126

RESUMO

Monitoring prescription drug use patterns at the population level (1) can inform research and clinical practice. These patterns may shift over time in response to changing health needs, updated clinical guidelines (2), policy changes, and other factors (1,3). The percentage of the U.S. population that used one or more prescription drugs increased from 1999-2000 through 2007-2008 (4). This report describes prescription drug use by age, sex, and race and Hispanic origin in 2015-2016 and trends over the preceding decade.


Assuntos
Comportamentos Relacionados com a Saúde , Medicamentos sob Prescrição/provisão & distribução , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos
11.
J Community Health Nurs ; 36(2): 78-85, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30990746

RESUMO

Access to medications is a critical determinant of health which often mediates the effects of diseases and leads to healthier lifestyles. With limited access to pharmacies, neighborhoods become pharmacy deserts. The purpose of this study was to explore the medication needs and perceptions of low-income community residents. A purposive sample of 40 low-income community residents participated in focus groups. Content analysis revealed four themes: transitioning to the present, stereotyping, feelings of disconnectedness, and ideal pharmacy. These findings reiterate the difficulties of living in pharmacy deserts, and decrease the gaps of limited qualitative research in this area.


Assuntos
Acesso aos Serviços de Saúde , Farmácias/provisão & distribução , Pobreza , Medicamentos sob Prescrição/provisão & distribução , Idoso , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Grupos Minoritários , Características de Residência , Tennessee , População Urbana
12.
PLoS Negl Trop Dis ; 13(4): e0007190, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973876

RESUMO

A subset of anti-infective drugs are increasingly unavailable for patients in the United States due to pricing or withdrawal from the market. Timely market solutions are needed. We assert that solutions to ensure access to some essential anti-infective agents lie outside capital markets and that public-private partnerships may be the most viable solution.


Assuntos
Anti-Infecciosos/provisão & distribução , Doenças Transmissíveis/tratamento farmacológico , Indústria Farmacêutica/economia , Anti-Infecciosos/economia , Indústria Farmacêutica/legislação & jurisprudência , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribução , Setor Público , Estados Unidos , United States Food and Drug Administration
13.
PLoS One ; 14(3): e0213403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30917142

RESUMO

OBJECTIVES: To test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region. METHODS: Data: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform's announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase. RESULTS: General: Reduction (-13.04) in consumption after the reform's implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform's implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling). CONCLUSIONS: The negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.


Assuntos
Dedutíveis e Cosseguros , Custos de Medicamentos , Medicamentos sob Prescrição/economia , Dedutíveis e Cosseguros/legislação & jurisprudência , Dedutíveis e Cosseguros/estatística & dados numéricos , Dedutíveis e Cosseguros/tendências , Custos de Medicamentos/legislação & jurisprudência , Custos de Medicamentos/estatística & dados numéricos , Custos de Medicamentos/tendências , Feminino , Humanos , Modelos Lineares , Masculino , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Pobreza/economia , Pobreza/estatística & dados numéricos , Medicamentos sob Prescrição/provisão & distribução , Espanha
14.
Tex Med ; 115(2): 28-31, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30817836

RESUMO

The Texas Medical Association supports allowing physicians to dispense out of their offices, and TMA and the Texas Academy of Family Physicians (TAFP) are supporting business groups and other leaders as they mount a legislative effort to bring the practice to Texas. Proponents are wielding data that illustrates potential benefits like reduced medication costs and increased patient adherence to their drug regimens.


Assuntos
Padrões de Prática Médica/organização & administração , Medicamentos sob Prescrição/provisão & distribução , Humanos , Padrões de Prática Médica/economia , Padrões de Prática Médica/legislação & jurisprudência , Medicamentos sob Prescrição/economia , Texas
19.
Neonatology ; 115(2): 108-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30384374

RESUMO

BACKGROUND: Prescription drug shortages have increased significantly during the past two decades and also impact drugs used in critical care and pediatrics. OBJECTIVES: To analyze drug shortages affecting medications used in neonatal intensive care units (NICUs). METHODS: Drug shortage data for the top 100 NICU drugs were retrieved from the University of Utah Drug Information Service from 2001 to 2016. Data were analyzed focusing on drug class, formulation, reason for shortage, and shortage duration. RESULTS: Seventy-four of the top 100 NICU drugs were impacted by 227 shortages (10.3% of total shortages). Twenty-eight (12.3%) shortages were unresolved as of December 2016. Resolved shortages had a median duration of 8.8 months (interquartile range 3.6-21.3), and generic drugs were involved in 175 (87.9%). An alternative agent was available for 171 (85.8%) drugs but 120 (70.2%) of alternatives were also affected by shortages. Parenteral drugs were involved in 172 (86.4%) shortages, with longer durations than nonparenteral drugs (9.9 vs. 6.4 months, p = 0.022). The most common shortage reason was manufacturing problems (32.2%). CONCLUSIONS: Drug shortages affected many agents used in NICUs, which can have quality and safety implications for patient care, especially in extremely low birth weight infants. Neonatologists must be aware of current shortages and implement mitigation strategies to optimize patient care.


Assuntos
Medicamentos Genéricos/provisão & distribução , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/normas , Medicamentos sob Prescrição/provisão & distribução , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/organização & administração , Neonatologistas , Estados Unidos
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