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2.
BMJ ; 367: l6015, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690553

RESUMO

OBJECTIVE: To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns. DESIGN: Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare). SETTING: Primary care, France. PARTICIPANTS: 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database. MAIN OUTCOME MEASURES: The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses. RESULTS: The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (-€5.33 (99.9% confidence interval -€6.99 to -€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (-0.68%, -1.13% to -0.23% compared with the €240-€999 group) and vasodilators (-0.15%, -0.28% to -0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors. CONCLUSION: The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded. TRIAL REGISTRATION: OSF register OSF.IO/8M3QR.


Assuntos
Indústria Farmacêutica/economia , Prescrições de Medicamentos/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Doações , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Indústria Farmacêutica/estatística & dados numéricos , Prescrições de Medicamentos/economia , Medicamentos Genéricos/economia , Feminino , França , Clínicos Gerais/economia , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Padrões de Prática Médica/economia , Medicamentos sob Prescrição/economia , Estudos Retrospectivos , Adulto Jovem
3.
Rev Esp Salud Publica ; 932019 Aug 05.
Artigo em Espanhol | MEDLINE | ID: mdl-31378781

RESUMO

OBJECTIVE: The high pharmaceutical consumption requires establishing improvement measures with the collaboration of all the agents involved. The objective of the study was to analyze the pharmaceutical expenditure generated by prescriptions made by physicians working in a primary care area and assess its relationship with the quality indicators of the prescription. METHODS: The prescriptions of 200 family physicians of the Basque Health Service Araba Countyand dispensed by the community pharmacies between 2009 and 2016 were studied. The variables evaluated retrospectively corresponded to the quality indicators of the pharmaceutical prescription included in the Contract-Program of the Basque Department Health of 2016. Prediction models were developed using linear regression and binary logistic regression analysis. RESULTS: The main factors which increased the pharmaceutical expenditure per person were: the use of novel drugs which do not offer therapeutic improvements, the proportion of pensioners, the use of statins and the use of antiulcer the proton pump inhibitors (PPI). On the contrary, the factors that reduced this expense were: the seniority in the medical position, the physician job stability and the prescription quality index. The profile of the doctor who generated the greatest expense of pharmaceutical prescription was mainly that of a professional who was responsible for a high percentage of pensioners, prescribed a high amount of inhibitors of the enzyme angiotensin converting enzyme inhibitors (ACEI), prescribed a high amount of first level non-steroidal anti-inflammatory drugs (NSAIDs) and also showed high use of antiulcer PPI. CONCLUSIONS: There is a statistically significant correlation between physicians who generate lower pharmaceutical expenditure and have a higher quality of prescription. The most influencing factors in the pharmaceutical expenditure are a high percentage of pensioners in the medical quota, the use of novel drugs that do not provide therapeutic improvements and the prescription of statins and anti-ulcer PPI drugs.


Assuntos
Prescrições de Medicamentos/economia , Gastos em Saúde/normas , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Idoso , Anti-Inflamatórios não Esteroides/economia , Antiulcerosos/economia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Farmácias , Atenção Primária à Saúde/economia , Inibidores da Bomba de Prótons/economia , Análise de Regressão , Estudos Retrospectivos , Espanha/epidemiologia
4.
BMC Health Serv Res ; 19(1): 373, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196079

RESUMO

BACKGROUND: Hypertension remains one of the leading causes of death in Nigeria. Appropriate and cost-effective treatment of the disease is necessary to reduce mortality. This study evaluates (i) the prescription patterns and quality (ii) blood pressure control and (iii) cost of medication among patients with hypertension uncomplicated by co-morbid diseases or compelling indications. METHOD: Patients with uncomplicated hypertension attending three clinics in the University College Hospital, Ibadan in Nigeria were recruited into this study. Information on demographics, antihypertensive medication prescribed, blood pressure measurements, and cost of medications were collected for each patient. Antihypertensive medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) system. The frequency of usage of each drug class and their prescribed doses per patient/day were calculated and compared with the DDD to assess the quality of prescription. Cost of antihypertensive medication was calculated for each patient and reported as cost per patient/day and cost per patient/month. Effect of variables on BP control was ascertained. Statistical analyses were done using SPSS, chi-square and correlation test was used to test for associations. RESULT: A total number of 1050 hypertensive patients were included in this study. The mean age was 60 years, females made up 62% of the study population. A high level of polypharmacy (87%) and sub-optimal blood pressure control was observed. An increase in blood pressure was observed with increase in the number of medication prescribed (χ2 = 33.618, p < 0.001; r = .18, p < 0.001). The most prescribed antihypertensive medication either as a single therapy or a fixed-dose combination was diuretic. About 54% of the prescribed daily doses of antihypertensive medication exceeded the DDD. The total monthly expenditure on antihypertensive drugs was approximately N3.2 million ($15,300). CONCLUSION: Study findings show a high level of polypharmacy and non-generic prescribing. Increased prescribing of drugs that are cost-effective, as well as prescription of fixed dose combinations (FDCs), is recommended in hypertensive patients. This is necessary to control blood pressure while increasing treatment adherence.


Assuntos
Anti-Hipertensivos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Hipertensão/tratamento farmacológico , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/economia , Análise Custo-Benefício , Prescrições de Medicamentos/economia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/economia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia
6.
Niger J Clin Pract ; 22(5): 626-632, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31089016

RESUMO

Background: Widespread irrational medical prescription adversely affects the outcomes of patient health and medical services. Aim: This study aims to investigate the determinants of medical prescription behavior of family physicians in Erzurum Province. Materials and Methods: This cross-sectional descriptive study was conducted during August-December 2016 on a voluntary sample of 191 out of 234 physicians (81.6%) working at family health centers in the districts of Erzurum. Physicians were visited at their workplaces, and data were collected using a self-administered and structured, 45-item questionnaire. Results: The mean age of the physicians was 34.7 ± 7.9 years, and 70.7% (n = 135) of the participants were males. About 83.8% (n = 160) of physicians responded "yes" or "sometimes" to the question "Do you prescribe medicine on demand of the patients?" The two most important factors that affected the prescribing behavior of the participants were the pharmacology lectures attended during medical education (50.8%) and the prescribing experience acquired during clinical internship (46.0%). Presentations given by the representatives of drug companies, in-service training programs after graduation, and Internet/mobile phone applications had the lowest rate of contribution as behavioral determinants. The participants perceived having sufficient information in the areas of indication for use (77.5%) and daily dose (72.8%). Only 4.2% of participants deemed their knowledge of medication costs sufficient. Pharmacology lessons were found to be more effective in the prescribing behaviors of the physicians who had less than 10 years of professional experience (Chi-square = 12.131; P = 0.002). Conclusion: Rational medical prescription continues to be a trouble among family physicians. The study findings suggest a substantial knowledge gap in participating physicians occurring after graduation and clinical internship training, in the areas of costs of medicine and rational medical prescribing.


Assuntos
Prescrições de Medicamentos , Medicina de Família e Comunidade/educação , Farmacologia/educação , Padrões de Prática Médica , Adulto , Competência Clínica , Estudos Transversais , Custos de Medicamentos , Prescrições de Medicamentos/economia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência , Masculino , Preferência do Paciente , Inquéritos e Questionários , Turquia
7.
Medicine (Baltimore) ; 98(22): e15914, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145355

RESUMO

The objective of this study was to examine whether patient income has an impact on likelihood of being prescribed an antimicrobial agent at the county level. A better understanding of factors that influence antimicrobial prescription is needed to efficiently mitigate rates of antimicrobial agents prescribed.This cross-sectional study used data from two publicly available datasets. The 2015 Medicare Part D PUF data quantifies the antimicrobial prescription rate at the county level and data from US Census Bureau provides information on socioeconomic status at the county level.At the county level, we explained 48% of the variation in antimicrobial prescriptions by socioeconomic status, age, gender, and race. More specifically, socioeconomic status accounted for 26% of the variation in antimicrobial rate and as income increased, correlation with antimicrobial prescription rate trended down.We determined patient income and other sociodemographics to influence the prescription of antimicrobial agents. Interventions should consider these factors to effectively evaluate antimicrobial prescription methods. Findings from this study can help guide intervention efforts which aim to minimize the number of inappropriate antimicrobials prescribed, such as antimicrobial stewardship programs. Effective interventions have the capability of decreasing levels of inappropriate antimicrobials prescribed and prevent future cases of resistance.


Assuntos
Anti-Infecciosos/economia , Prescrições de Medicamentos/economia , Renda/estatística & dados numéricos , Medicare Part D/estatística & dados numéricos , Idoso , Estudos Transversais , Feminino , Geografia , Humanos , Masculino , Classe Social , Estados Unidos
8.
Haemophilia ; 25(4): 668-675, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993845

RESUMO

BACKGROUND: Extended half-life (EHL) factor VIII (FVIII) and IX (FIX) products are intended to decrease the burden of prophylaxis for patients with haemophilia A or B. Whether these newer concentrates have led to meaningful clinical practice change remains vague. AIM: To characterize the longitudinal use of standard (SHL) and EHL factor concentrates at haemophilia treatment centres (HTCs), using the ATHNdataset, a US database of 138 ATHN-affiliated HTCs. METHODS: Factor concentrate use among moderate and severe haemophilia A and B patients without inhibitors was analysed at three time points over 18 months. RESULTS: Use of EHL concentrates rose from 10% of patients to 22% during this study. EHL FVIII prophylaxis is prescribed to the minority of patients, 28%; EHL FIX now predominates for prophylaxis, 52%. Rates of prescribed EHL products varied significantly by age group and HTC region. Median prescribed prophylaxis for SHL compared to EHL products was FVIII 6240 and 5200 and FIX 6968 and FIX 3900 IU/kg/y, respectively. On-demand EHL use has grown but has minimal contribution to overall usage (2%). CONCLUSION: Haemophilia treatment centre region and patient age impact the rate of adoption of EHL products; however, EHL prescribing continues to rise nationally, particularly for EHL FIX. Careful attention to annual cost of prophylaxis is imperative as the decrease in median EHL prophylaxis consumption is not offset by the higher unit cost of these products. It is unclear how further growth in use of EHLs will be impacted by emerging non-factor replacement and gene therapies.


Assuntos
Custos e Análise de Custo , Fator IX/economia , Fator IX/uso terapêutico , Fator VIII/economia , Fator VIII/uso terapêutico , Hemofilia A/tratamento farmacológico , Hemofilia B/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Criança , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Fator IX/farmacocinética , Fator VIII/farmacocinética , Feminino , Geografia , Meia-Vida , Hemofilia A/metabolismo , Hemofilia B/metabolismo , Humanos , Estudos Longitudinais , Masculino , Estados Unidos , Adulto Jovem
9.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30914443

RESUMO

BACKGROUND AND OBJECTIVES: Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used. METHODS: This is a retrospective study of children ages 1 to 18 years using Medicaid from 10 states in 2014 grouped by the annual number of CMs (0, 1, 2-4, 5-9, and ≥10 medications), which are defined as a dispensed ≥30-day prescription with ≥2 dispensed refills. Trends in clinical characteristics and health care use by number of CMs were evaluated with the Cochran-Armitage trend test. RESULTS: Of 4 594 061 subjects, 18.8% used CMs. CM use was 44.4% in children with a complex chronic condition. Across all children, the most common CM therapeutic class was neurologic (28.9%). Among CM users, 48.8% used multiple CMs (40.3% used 2-4, 7.0% used 5-9, and 0.5% used ≥10). The diversity of medications increased with increasing number of CMs: for 1 CM, amphetamine stimulants were most common (29.0%), and for ≥10 CMs, antiepileptics were most common (7.1%). Of $2.3 billion total pharmacy spending, 59.3% was attributable to children dispensed multiple CMs. Increased CM use (0 to ≥10 medications) was associated with increased emergency department use (32.1% to 56.2%) and hospitalization (2.3% to 36.7%). CONCLUSIONS: Nearly 1 in 5 children with Medicaid used CMs. Use of multiple CMs was common and correlated with increased health care use. Understanding CM use in children should be fundamentally important to health care systems when strategizing how to provide safe, evidence-based, and cost-effective pharmaceutical care to children.


Assuntos
Doença Crônica/tratamento farmacológico , Custos de Medicamentos , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Medicaid/economia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Prescrições de Medicamentos/economia , Feminino , Custos de Cuidados de Saúde , Humanos , Lactente , Masculino , Medicaid/estatística & dados numéricos , Polimedicação , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estados Unidos , Populações Vulneráveis
10.
Psychopharmacology (Berl) ; 236(9): 2641-2652, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30927021

RESUMO

RATIONALE: Non-medical prescription opioid use and opioid use disorder (OUD) present a significant public health concern. Identifying behavioral mechanisms underlying OUD will assist in developing improved prevention and intervention approaches. Behavioral economic demand has been extensively evaluated as a measure of reinforcer valuation for alcohol and cigarettes, whereas prescription opioids have received comparatively little attention. OBJECTIVES: Utilize a purchase task procedure to measure the incremental validity and test-retest reliability of opioid demand. METHODS: Individuals reporting past year non-medical prescription opioid use were recruited using the crowdsourcing platform Amazon Mechanical Turk (mTurk). Participants completed an opioid purchase task as well as measures of cannabis demand, delay discounting, and self-reported pain. A 1-month follow-up was used to evaluate test-retest reliability. RESULTS: More intense and inelastic opioid demand was associated with OUD and more intense cannabis demand was associated with cannabis use disorder. Multivariable models indicated that higher opioid intensity and steeper opioid delay discounting rates each significantly and uniquely predicted OUD. Increased opioid demand intensity, but not elasticity, was associated with higher self-reported pain, and no relationship was observed with perceived pain relief from opioids. Opioid demand showed acceptable-to-good test-retest reliability (e.g., intensity rxx = .75; elasticity rxx = .63). Temporal reliability was lower for cannabis demand (e.g., intensity rxx = .53; elasticity rxx = .58) and discounting rates (rxx = .42-.61). CONCLUSIONS: Opioid demand was incrementally valid and test-retest reliable as measured by purchase tasks. These findings support behavioral economic demand as a clinically useful measure of drug valuation that is sensitive to individual difference variables.


Assuntos
Analgésicos Opioides/administração & dosagem , Mercantilização , Desvalorização pelo Atraso/efeitos dos fármacos , Economia Comportamental , Medição da Dor/efeitos dos fármacos , Adulto , Analgésicos Opioides/economia , Desvalorização pelo Atraso/fisiologia , Prescrições de Medicamentos/economia , Feminino , Humanos , Masculino , Fumar Maconha/economia , Fumar Maconha/psicologia , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/psicologia , Medição da Dor/economia , Medição da Dor/psicologia , Reprodutibilidade dos Testes , Fatores de Risco , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
11.
Pesqui. bras. odontopediatria clín. integr ; 19(1): 4186, 01 Fevereiro 2019. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-997897

RESUMO

Objective: To analyse economic burden of selected analgesic drugs prescription by dentists in Slovakia over a 24-month period. Material and Methods: In this economic burden study, the data were provided from the largest public health insurance company in Slovakia. It was analysed 23,256 prescriptions of selected analgesic drugs (Acetylsalicylic Acid, Diclofenac, Nimesulide, Tramadol and Metamizole Sodium) by dentists in Slovakia. Results: The highest analgesics prescription by dentists was found in Diclofenac in 2016 with 11.2% prescription increase in 2017. The significant decrease of analgesic drug prescription by dentists in 2017 was observed in Tramadol (-29.9%). The economic burden of selected analgesic drugs by patients were €33,926 in 2017 with 21.3% significant decrease of average percentage differences (APD) in Tramadol and 84.6% significant increase of APD in Metamizole sodium in 2017. Patients participated 65.5% share in payment of selected analgesic drugs and Health Insurance Company participated only 34.5% share in payment of selected analgesic drugs in 2017. It was found increase of percentage analgesic drugs prescription in Diclofenac and Nimesulide and decrease of percentage drug prescription in Metamizole sodium from 1/2016 to 12/2017. Conclusion: Economic burden on analgesic drugs prescribed by dentist was low per Slovak inhabitant in calculated. Diclofenac was most frequent prescribed analgesic drug with the highest economic burden. We recommend prescribing cheaper analgesic drugs with a lower economic burden and with the same effect.


Assuntos
Prescrições de Medicamentos/economia , Custos de Cuidados de Saúde , Eslováquia , Custos e Análise de Custo/economia , Odontólogos , Interpretação Estatística de Dados , Analgésicos/uso terapêutico
13.
Nat Rev Genet ; 20(1): 1-2, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30348998

RESUMO

Personalized medicine promises to advance and improve health by targeting the right medication to the right person at the right time, thus maximizing the proportion of treated patients who achieve an effective response to therapy. This Comment article makes the complementary argument that equally important benefits will derive from negative prediction, namely by identifying those individuals who are either not actually in need of, or unlikely to respond to, a drug. Reduction of unnecessary prescription could conceivably save health-care systems many billions of dollars with very little detrimental impact on outcomes.


Assuntos
Prescrições de Medicamentos/economia , Genômica/métodos , Farmacogenética/métodos , Medicina de Precisão/métodos , Genômica/economia , Humanos , Farmacogenética/economia , Medicina de Precisão/economia
14.
Drug Alcohol Depend ; 194: 330-335, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30472572

RESUMO

BACKGROUND: The role of prescription opioids in the opioid crisis has been well established. How the prevalence of prescription opioids relates to opioid hospitalizations has been understudied. Hospitalizations due to opioids are a distinct indicator of opioid misuse, have cost implications for health care systems, and may be an entry point into substance use treatment. METHODS: Administrative data were drawn for counties in 32 U.S. states from 2011 to 2014 to associate retail opioid sales rates with opioid-related hospitalization rates. Data on hospitalizations comes from the Healthcare Cost and Utilization Project. Data on opioid sales come from the Automation of Reports and Consolidated Orders System. Statistical models were run accounting for error in the opioid sales measure and controlled for county and year effects and other factors. Sub-analyses explored hospitalizations by metropolitan status and maternal/neonatal stays. As a point of comparison, the analysis estimated the relationship of opioid sales to alcohol hospitalizations. RESULTS: Retail opioid sales rates have a positive relationship with opioid-related hospitalization rates where a one morphine kilogram equivalent (MKE) increase in sales per 10,000 people predicts a 9.0% (CI 4.6%-13.7%) increase in opioid-related hospitalization rates. The relationship is higher in non-metropolitan counties. Maternal and neonatal opioid-related hospitalization rates increase by 14.1% (CI 4.9%-24.2%) with a one MKE increase in retail sales rates. There is no statistically significant relationship between opioid sales and alcohol hospitalizations. CONCLUSIONS: Though not causal, results inform understanding of how opioid prescribing relate to adverse consequences of opioid use and misuse.


Assuntos
Analgésicos Opioides/efeitos adversos , Prescrições de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Analgésicos Opioides/economia , Prescrições de Medicamentos/economia , Feminino , Custos de Cuidados de Saúde , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Transtornos Relacionados ao Uso de Opioides/economia , Gravidez , Prevalência , População Rural , Estados Unidos/epidemiologia , População Urbana
16.
Phys Sportsmed ; 47(1): 10-14, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30247933

RESUMO

Performance enhancing substances are becoming increasingly popular amongst bodybuilders and people who want to enhance their physiques. However, due to the rise of the Internet and laws prohibiting sales of these substances without prescription, the route of procurement and administration practices have become more and more dangerous. Prior to the mid-1970's, anabolic steroids were not regulated and easily available from physicians and pharmacies in several countries. In 1990, the United States enacted the Anabolic Steroid Control Act, leading to the proliferation of black markets and underground laboratories. The shift from pharmacy to underground online sites for the procurement of anabolic steroids led to an increase of fake products with low purity and the ability to potentially endanger the health of anabolic steroid users. Underground laboratories emerged both locally and in countries with lax legal regulations. 'Anabolic steroid tourism' and large networks of online resellers emerged, leading to the banalisation of the illegal procurement of anabolic steroids. Furthermore, the increase of anecdotal information spreading on the internet among anabolic steroid user forums nourishes the rampant misinformation and dangerous practices that currently exist. The dosages and ways of administration recommended on these forums can be false and misleading to those who lack a medical background and cannot go to their physician to seek advice because of the fear of repercussions. This review aims to elucidate and describe current practices of the anabolic-androgenic steroids black market and draw attention to potential dangers for users.


Assuntos
Comércio , Doping nos Esportes , Legislação de Medicamentos , Congêneres da Testosterona/economia , Doping nos Esportes/legislação & jurisprudência , Prescrições de Medicamentos/economia , Tráfico de Drogas , Humanos , Internet
17.
Health Care Women Int ; 40(1): 33-46, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29494785

RESUMO

Researchers' aim was to investigate if patients/physicians characteristics could differently affect males/females health care expenditure. In 2009/2010, a health-related-quality-of-life (HRQL) measure was distributed to 887 general practitioners' (GP) patients in Siena's province-Italy. Severity of diseases was calculated through Cumulative Illness Rating Scale Severity Index (CIRS-SI). Information about GPs' gender and age and patients' gender, age, and socio-economic variables were recorded. 2012 data about pharmaceutical, outpatient and hospital expenditure were obtained. Multivariate regression was carried out. In males, hospital expenditure increased with higher CIRS-SI and female GP whilst in females it was not influenced by any of the variables. Outpatient and pharmaceutical expenditure increased with aging, higher CIRS-SI, and lower HRQL and education, both in males and females. Gender differences in health expenditure determinants emerged for hospital expenditure.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Prescrições de Medicamentos/economia , Gastos em Saúde/estatística & dados numéricos , Tempo de Internação/economia , Qualidade de Vida , Adulto , Fatores Etários , Idoso , Envelhecimento , Prescrições de Medicamentos/estatística & dados numéricos , Tratamento Farmacológico/economia , Feminino , Medicina Geral , Clínicos Gerais , Pesquisas sobre Serviços de Saúde , Nível de Saúde , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
18.
J Oncol Pharm Pract ; 25(7): 1570-1575, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30249154

RESUMO

BACKGROUND: Oral chemotherapy agents are being prescribed more frequently in many cancer types. In-office dispensing of oral chemotherapy agents has demonstrated clinical benefits and also shown financial benefit to third-party payers. A previous publication estimated over $200,000 in cost savings annually from in-office dispensing solely from medications returned to stock for credit. However, pharmacists in the in-office setting perform many other interventions that may affect financial outcomes. OBJECTIVE: Assess financial impact of oral chemotherapy in-office dispensing by a clinic-based oral chemotherapy program serving five outpatient cancer centers in Southern Idaho. Outcomes include calculated monetary waste and cost avoidance of oral chemotherapy prescriptions from in-office dispensing and mail-order pharmacies. METHODS: Prescriptions received by the clinic-based oral chemotherapy program for filling through in-office dispensing and mail-order pharmacies were monitored for monetary waste and cost avoidance events from December 2016 through May 2017. Information was collected on the number of returned medications, therapy discontinuations, and dose adjustments. Monetary outcomes were calculated using average wholesale price. RESULTS: During the six-month evaluation, prescriptions filled through in-office dispensing had a total cost avoidance of $1,020,193 (n = 154) and total waste of $154,985 (n = 36) resulting in an estimated net cost avoidance annually of $1,730,416. Prescriptions filled through mail-order had a total cost avoidance of $20,497 (n = 4) and a total waste of $80,394 (n = 15) resulting in an estimated $119,794 net annual waste. CONCLUSIONS: In-office dispensing of oral chemotherapy provided significant cost savings to third-party payers compared to mail-order pharmacy dispensing. Continued evaluation may help further justify the importance and value of in-office dispensing.


Assuntos
Antineoplásicos/uso terapêutico , Prescrições de Medicamentos/economia , Neoplasias/tratamento farmacológico , Assistência Farmacêutica/economia , Administração Oral , Antineoplásicos/economia , Redução de Custos , Humanos , Serviços Postais
19.
BMC Health Serv Res ; 18(1): 1013, 2018 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-30594189

RESUMO

BACKGROUND: China ranks first amongst the countries for the abuse of antibacterials. Essential antibacterials could help solve the problem. The aim of the work is to evaluate the availability, price and affordability of essential antibacterials in Hubei province, China. METHOD: The standardized methodology developed by the World Health Organization and Health Action International was used to collect data on the availability and prices of 16 antibacterials in 5 cities of Hubei province, China. RESULTS: First, in total, the median availability of originator brands and lowest-priced generics for the essential antibacterials was low, 3.0% (0.0, 18.2%) and 33.3% (0.0, 87.9%) for each, respectively. Second, the median price ratio of originator brands for the antibacterials was 20.30 (4.71, 35.80), while for generics, it was 0.49 (0.07, 1.18). Third, the affordability of originator brands for the antibacterials was 28.14 (21.70, 41.90) times the daily wages of an unskilled government worker, while for generics, the affordability was 0.35 (0.04, 6.11). Finally, we found that in Hubei province, lowest-priced generics for essential antibacterials with (fairly) high availability and relatively low price included Amoxicillin/Clavulanic Acid, Ceftazidime, Metronidazole, Gentamicin Sulfate and Ceftriaxone. CONCLUSION: The prices of lowest-priced generics for essential antibacterials in Hubei province were reasonable, and in tertiary hospitals the availability was the highest, while in secondary and primary hospitals, it was relatively lower. Originator brands were not only extremely expensive but also difficult to obtain. Measures should be taken to improve the availability of essential antibacterials and the affordability of originator brands.


Assuntos
Antibacterianos/economia , Prescrições de Medicamentos/economia , Medicamentos Essenciais/economia , Padrões de Prática Médica/estatística & dados numéricos , Antibacterianos/provisão & distribução , China , Prescrições de Medicamentos/estatística & dados numéricos , Farmacorresistência Bacteriana , Medicamentos Essenciais/provisão & distribução , Política de Saúde , Humanos , Padrões de Prática Médica/economia , Organização Mundial da Saúde
20.
BMJ Open ; 8(12): e021318, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30567818

RESUMO

OBJECTIVES: To identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))-when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which prescriptions were historically free. DESIGN: Natural experimental retrospective general practice level interrupted time series (ITS) analysis using administrative data. SETTING: General practices, Scotland, UK. PARTICIPANTS: 732 (73.6%) general practices across Scotland with valid dispensed medicines and hospital admissions data during the study period (July 2005-December 2013). INTERVENTION: Reduction in fees per dispensed item from April 2008 leading to the abolition of the fee in April 2011, resulting in universal free prescriptions. PRIMARY AND SECONDARY OUTCOMES: Hospital admissions recorded in the Scottish Morbidity Record - 01 Inpatient (SMR01) and dispensed medicines recorded in the Prescribing Information System (PIS). RESULTS: The ITS analysis identified marked step reductions in adult (19-59 years) admissions related to asthma or COPD (the intervention group), compared with older or young people with the same conditions or adults with diabetes mellitus (the counterfactual groups). The prescription findings were less coherent and subsequent sensitivity analyses found that both the admissions and prescriptions data were highly variable above the annual or seasonal level, limiting the ability to interpret the findings of the ITS analysis. CONCLUSIONS: This study did not find sufficient evidence that universal free prescriptions was a demonstrably effective or ineffective policy, in terms of reducing hospital admissions or reducing socioeconomic inequality in hospital admissions, in the context of a universal, publicly administered medical care system, the National Health Service of Scotland.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Glucocorticoides/economia , Admissão do Paciente/estatística & dados numéricos , Honorários por Prescrição de Medicamentos , Adolescente , Adulto , Asma/tratamento farmacológico , Asma/epidemiologia , Bases de Dados Factuais , Prescrições de Medicamentos/economia , Glucocorticoides/uso terapêutico , Humanos , Análise de Séries Temporais Interrompida , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Escócia/epidemiologia , Cobertura Universal do Seguro de Saúde , Adulto Jovem
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