Defining opioid naïve and implications for monitoring opioid use: A population-based study in Alberta, Canada.

PURPOSE: Reducing initial exposure of "opioid naïve" patients to opioids is a public health priority. Identifying opioid naïve patients is difficult, as numerous definitions are used. The objective is to summarize current definitions and evaluate their impact on opioid naïve measures in Alberta. METHODS: An exploratory data analysis of the literature was conducted over the last 10 years to identify definitions commonly used in the literature to define opioid naïve. Then, using these definitions as a guide, we descriptively report the proportion of patients in Alberta between 2017 and 2021 who would be considered as opioid naïve using these definitions and all opioid dispensing data. RESULTS: Three categories of definitions were broadly identified: (1) no opioid use within the previous 30 days/6 months/1 year, based on dispensation date; (2) no opioid use based on dispensation date plus days of supply; and, (3) exclusion of codeine from Definitions 1 and 2. Applying these definitions to the Alberta population showed a very wide range in the proportion who would be considered as opioid naïve. Overall, 36.4% of Albertans (n = 1 551 075) had an opioid dispensation in 2017-2021. The average age was 46.6 ± 18.8 and 52.8% were female. The proportion of opioid naïve were most affected by the "opioid free" period, with 97.4%, 83.2%, and 65.6% being classified as opioid naïve using time windows from Definition 1 (30 days, 6 months, 1 year of no prior opioid use). Definitions 2 and 3 did not materially change the results. Further extending the "opioid free" period to 2 years showed only 35% were opioid naïve. CONCLUSIONS: The most convenient definition for "opioid naïve" was the use of an "opioid free" period. The choice of window would depend on how the information may be used to assistant in clinical decisions with longer windows more likely to reflect true opioid naïve patients. Irrespective of definition used, a large proportion of opioid users would be considered opioid naïve in Alberta.

[Existing report of the health care of detainees and of the organization of the drug circuit in prisons in France]. / État des lieux de la prise en charge sanitaire des détenus et de l'organisation du circuit médicamenteux en milieu carcéral en France.

Since the healthcare system reform in prisons by the law of 18 January 1994, health care for prisoners has depended on the public hospital service. Since the application of this law, hospital pharmacists have been responsible for the health product circuit in the prison. In order to reassess the overall health care of detainees in prison in 2022, a study is being carried out. This study also aims to carry out an inventory of the organization of the drug circuit in prisons in France. In June 2022, a questionnaire was sent by email to pharmacists in charge of supplying health products to one or more prison health units in France. The response rate to the questionnaire is 34 %. The average number of full-time equivalent (FTE) somatic doctors is 1.25. The average FTE pharmacist and pharmacy technician are respectively 0.4 and 0.96. Prescriptions are computerized in 84 % of cases. Therapeutic education and pharmaceutical interviews are carried out in 24 % and 20 % respectively. This study showed an overall improvement in the care of prisoners and the organization of the medication circuit in France compared to the last study. Pharmacists are more present in prisons. However, clinical pharmacy and health promotion actions are insufficiently deployed.

[Drug dispensation at both community and hospital pharmacy, the highly active antiretrovirals example]. / Le double circuit de dispensation, exemple des traitements antirétroviraux : quelle pertinence ?

OBJECTIVES: Highly active antiretroviral therapies against the human immunodeficiency virus are available for patients in France in community pharmacy or in hospital pharmacy. More than 20 years after the implementation of the dual delivery system, it seems necessary to question the relevance of the dual dispensing circuit both in terms of service provided to patients and expenditure for health insurance. METHODS: The health insurance files were used to quantify the delivery of antiretrovirals therapies in the community pharmacy and in the hospital pharmacy. A survey was performed involving patients to find out their point of view on dispensing in hospital pharmacy and were the patients came from. The differential cost from the health insurance point of view between the two delivery system was calculated on the basis of the quantities delivered and the purchase prices at the hospital center in 2018. RESULTS: More than 80% of the quantities of antiretrovirals therapies are now delivered by community pharmacies. The arguments in favor of the antiretrovirals therapies dispensation by hospital pharmacy forwarded by patients are the anonymity and constant medicines availability. Health insurance is required to refund a drug at different prices depending on the delivery place, for about 37€ per box in favour of hospital dispensing. CONCLUSION: This study presents a complete inventory of the dual delivery system for antiretroviral therapies. Hospital and community therefore remain complementary to welcome outptients who will seek different delivery methods there. Little known to patients and professionals, this dual delivery system generates complexities at the stages of prescription, dispensing and reimbursement. It only concerns a minority of patients and its benefit for health insurance seems uncertain.

Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study.

PURPOSE: Despite being discouraged by guidelines, long-term use of benzodiazepines and related Z-drugs (BZDR) remains frequent in the real-world. An improved understanding of factors associated with the transition from new to long-term BZDR use and of temporal BZDR use trajectories is needed. We aimed to assess the proportion of long-term BZDR use (> 6 months) in incident BZDR-recipients across the lifespan; identify 5-year BZDR use trajectories; and explore individual characteristics (demographic, socioeconomic and clinical) and prescribing-related factors (pharmacological properties of the initial BZDR, prescriber's healthcare level, and concurrent dispensing of other medications) associated with long-term BZDR use and distinct trajectories. METHODS: Our nationwide register-based cohort included all BZDR-recipients in Sweden with first dispensation in 2007-2013. Trajectories of BZDR use days per year were built using group-based trajectory modelling. Cox regression and multinomial logistic regression were fitted to assess the predictors of long-term BZDR use and trajectories' membership. RESULTS: In 930,465 incident BZDR-recipients, long-term use increased with age (20.7%, 41.0%, and 57.4% in 0-17, 18-64, and ≥ 65-year-olds, respectively). Four BZDR use trajectories emerged, labelled 'discontinued', 'decreasing', 'slow decreasing' and 'maintained'. The proportion of the 'discontinued' trajectory members was the largest in all ages, but reduced from 75.0% in the youths to 39.3% in the elderly, whereas the 'maintained' increased with age from 4.6% to 36.7%. Prescribing-related factors, in particular multiple BZDRs at initiation and concurrent dispensing of other medications, were associated with increased risks of long-term (vs short-term) BZDR use and developing other trajectories (vs 'discontinued') in all age groups. CONCLUSIONS: The findings highlight the importance of raising awareness and providing support to prescribers to make evidence-based decisions on initiating and monitoring BZDR treatment across the lifespan.

[What is the impact of changes in the drug circuit on dispensing activity during pharmaceutical duty?] / Quel impact des évolutions du circuit du médicament sur l'activité de dispensation durant la permanence pharmaceutique ?

INTRODUCTION: Pharmaceutical permanence (PP), outside the working hours of an in-house pharmacy (PUI), allows to guarantee the continuity of care in health-care institutions. A retrospective review of urgent drug dispensing was carried out in the light of changes in the drug circuit. MATERIALS AND METHOD: The analysis of drug dispensations was performed over a period from 2011 to 2019. The average number of drugs dispensed per shift, annual dispensations, and their variation by day of the week were studied. The increase is statistically significant and is found on both weekdays and weekends. Each drug was identified according to its Anatomical Therapeutic Chemical (ATC) classification. Data on the activities of our institution (number of hospitalizations, average length of stay) were also collected. RESULTS: In 2011, an average of 36 medications were dispensed per on-call period, compared with 77 in 2019 (a doubling of activity). The increase is statistically significant and is found on both weekdays and weekends. Neurological drugs and anti-infectives represent on average 43 % of the drugs dispensed. At the same time, there was a decrease in average length of stay and an increase in hospitalizations (-10 % and +16 % respectively). DISCUSSION: The increase in the average number of medications dispensed per shift is notable. It reflects a strong and gradual increase in activity, which was increased when the full vacuum cabinets (FVCs) were introduced, which improved the quality and safety of the pharmaceutical circuit. The revision of the allocations and the information of prescribers on the drug circuit will optimize the activity and refocus it on the pharmaceutical analysis of urgent needs.

[Preparation of doses to be administered: There is automated machine and automated machine]. / Préparation des doses à administrer : il y a automate et automate.

The new reference system of the national council of the order of pharmacists, relating to pharmacies for internal use, endorses the use of deconditioning machines. The authors express their disagreement by promoting the use of over-conditioning automatons and explain the reasons for this. They call for a debate.

Defining the duration of the dispensation of oral anticoagulants in administrative healthcare databases.

PURPOSE: In clinical practice, warfarin therapy requires frequent dose adjustments. In pharmacy claims, the days supplied value may not reflect the true duration of warfarin dispensation. This may affect the measures of association comparing the safety of direct oral anticoagulants (DOACs) versus warfarin. METHODS: Using Quebec healthcare administrative databases, we formed a cohort of 55 230 patients newly treated with oral anticoagulants between 2010 and 2016. The duration of dispensations was defined using two approaches: the recorded days supplied value, and the longitudinal coverage approximation (data-driven) that may account for individual variation in drug usage patterns. Propensity scores adjusted Cox proportional hazards regression models were used to estimate the hazard ratio (HR) of major bleeding with dabigatran or rivaroxaban versus warfarin. RESULTS: Using the days supplied, the mean (and standard deviation) dispensation durations for dabigatran, rivaroxaban, and warfarin were 19 (15), 19 (14), and 13 (12) days, respectively. Using the data-driven approach, the durations were 20 (16), 19 (15), and 15 (16) days, respectively. The choice of the approach had no impact on the HR estimates. CONCLUSIONS: In our settings, the data-driven approach closely approximated the recorded days supplied value for the standard dose therapies such as dabigatran and rivaroxaban. For warfarin, the data-driven approach captured more variability in the duration of dispensations compared to the days supplied value, which may better reflect the true drug-taking behavior of warfarin. Both approaches may provide valid estimates when comparing the safety of DOACs versus warfarin.

Patterns and Predictors of Outpatient Antibiotic Dispensation Following Total Hip and Knee Arthroplasty.

BACKGROUND: This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure. METHODS: In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral center were analyzed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation. RESULTS: Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge. CONCLUSION: A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care.

[Implementation of a territorial hospital pharmacy (PUI) ensuring a robotized nominative dispensation of treatments for two external sites: A dependent old people's home (EHPAD) and a follow-up care institution (SSR)]. / Carnet de bord pour la mise en place d'une PUI territoriale assurant une dispensation nominative robotisée des traitements pour deux sites extérieurs : Un EHPAD et un SSR.

The territorial hospital pharmacy (PUI) of the West of Paris, dispenses treatments for a follow-up care instituion (SSR) and a dependent old people's home (EHPAD) via a hospital pharmacy equipped with an automatic machine producing dry oral forms packaged in labeled pillboxes. This project was completed with the support of the Regional Health Agency (ARS) and aims to secure the medication circuit. The methodology for qualifying the computer system and production, the implementation of the medication circuit and the inter-site logistical organization are presented. The prescription software was interfaced with the management software, which is itself interfaced with the robot's, and with the automatic machine's software. Tests and developments allowed to convert dispensing units into prescription units over a period of time. Also, the drugs consumed by these two institutions allowed to establish the therapeutic booklet and drug provision as well as anticipating the automaton filling. Medical devices, solutions and narcotics are exclusively managed as supplies with a specific circuit. Treatments are dispensed weekly (pillboxes and off-robot). For the SSR, an additional daily production concerns the entries of new patients and the modifications of treatment. Automation saves time and security, but human intervention is involved on a daily basis. The institutions have adopted the new organization over about 6 months and the production activity is now smoothed out. In the next few weeks, two other EHPADs with 100 patients will be integrated into the PUI territorial. One of the main challenges is to integrate them into our pre-existing organization, while maintaining their habits.

[Aging population, dematerialization, a new deal for the pharmacy]. / Vieillissement de la population, dématérialisation, une nouvelle donne pour la pharmacie.

Home delivery has expanded across all retail sectors. During the first waves of the Covid-19 pandemic, pharmacists were approached by many of their patients who wanted to receive their medications at home. The question is whether this development is sustainable or merely cyclical.

Risk factors, awareness of disease and use of medications in a deprived population: differences between indigent natives and undocumented migrants in Italy.

BACKGROUND: Undocumented migrants experience many health problems; a comparison with a suitable control group of natives living in the same socio-economic conditions is still lacking. METHODS: Demographic data and data on risk factors, chronic conditions and dietary habits were obtained for 6933 adults (2950 Italians and 3983 undocumented migrants) receiving medical assistance from 40 non-governmental organizations all over the country. RESULTS: Attributed to the fact that these were unselected groups, differences were found in their demographic features, the main ones being their marital status (singles: 50.5% among Italians and 42.8% among migrants; P < 0.001). Smokers were more frequent among Italians (45.3% versus 42.7% P = 0.03); the same happened with hypertension (40.5% versus 34.5% P < 0.001). Migrants were more often overweight (44.1% versus 40.5% P < 0.001) and reporting a chronic condition (20.2% versus 14.4% P < 0.001). Among those on medications (n = 1354), Italians were fewer (n = 425) and on different medications. Differences emerged also in dietary habits. CONCLUSIONS: Differences in health conditions exist between native-borns and undocumented migrants, not because of a bias related to socio-economic conditions. Further studies are needed to design sustainable health policies and tailored prevention plans.

[Optimising drug dispensation by pharmacy technicians: A quality approach]. / Optimisation des dispensations réalisées par les préparateurs en pharmacie : démarche qualité en rétrocession.

INTRODUCTION: In a context of continuity of quality improvement, we are committed to enhancing the care management and medication management of outpatients in the drug dispensation unit of our pharmacy. An audit was carried out to assess the training needs of pharmacy technicians (PTs). MATERIALS AND METHODS: All drug dispensations done over a 9-week period by the units PTs were audited. Data collected were: PTs' presentation to the patient, duration of drug dispensation, notion of introduction or renewal, the tools used during retrocession, and the explanations given to the patient about her/his treatment. PT perceptions and patient satisfaction were evaluated on a Likert scale from 1 to 5 and on a scale from 1 to 4, respectively. RESULTS: One hundred drug dispensation were audited: 21 introductions and 79 renewals. Tools were used in 52% of introductions and 11% of renewals. Administration modalities were explained for all introductions but for only 57% of renewals, 47% of adverse events and 9.5% of storage methods. Tolerance was discussed in 34% of drug dispensations and compliance in 19%. The scores of PT perception and patient satisfaction were 4.4/5 and between 3/4 and 3.9/4 depending on the items, respectively. CONCLUSION: Several areas for improvement are highlighted in this survey. PTs' complementary should include communication with outpatients. This approach is an integral part of the ISO 9001 certification obtained in 2019 in our drug dispensation unit.

[Automation of the medication circuit to ensure patient safety]. / Automatisation du circuit du médicament dans la sécurisation du patient.

The medication circuit is a complex, transversal and risky process. It involves interdependent clinical and logistical stages. Its automation and computerisation are real levers for securing the patient's medication management and optimising the organisation of care. It allows care staff to free up precious time to provide care, particularly in geriatrics.

[Prospective risk analysis in a retrocession unit: Focus on drug dispensation process]. / Analyse des risques a priori en unité de rétrocession hospitalière : focus sur le processus de dispensation.

OBJECTIVES: Failure mode effect analysis (FMEA) improves safety in the drug life cycle. As the drug dispensation by hospital's pharmacy can be at risk, the FMEA tool has been used to evaluate and enhance the process. METHODS: After detailing the process, a first FMEA has been run in 2015. Corrective actions were implemented every time criticality indexes (CI) were above 15. One year later, we have evaluated potential impacts of these actions by running a new FMEA. RESULTS: In 2015, 11 failure modes were prioritized (CI>15) and the total CI for the overall process was 397. Corrective actions were implemented and one year later this amount has decreased by 14% (340) with 6 failure modes still prioritized. Thus, thanks to the FMEA, risks could be identified in year "y", they were taken into account and corrected and then effectively reassessed in year "y+1". CONCLUSION: This study showed us the interest of performing FMEA analysis in the drug dispensation process by hospital. The renewal of this risk analysis after a year helped us to monitor corrective actions, to evaluate their effectiveness and to improve safety. Finally, FMEA seems to be an effective way to steer the drug dispensation process.

A dedicated Fracture Liaison Service telephone program and use of bone turnover markers for evaluating 1-year persistence with oral bisphosphonates.

Telephone call intervention did not improve alendronate persistence in Fracture Liaison Service (FLS) patients in this study. A bone turnover marker cut-off point for alendronate persistence is proposed for individual FLS patients. INTRODUCTION: FLS aims to prevent subsequent fractures, which should include improving patients' persistence with prescribed oral bisphosphonates. We studied the influence of telephone calls and the predictive value of changes in bone turnover markers (BTMs) for evaluating persistence with alendronate. METHODS: Postmenopausal women with a recent fracture and osteoporosis who started alendronate were randomized to receive three phone calls (PC) (after 1, 4, and 12 months) or no phone calls (no PC). s-CTX and P1NP were measured at baseline and after 3, 6, 9, and 12 months. As a reference group, 30 postmenopausal osteopenic patients with a recent fracture were analyzed as well. Persistence was assessed using the Dutch National Switch Point Pharmacies-GPs database and cross-referenced with PC, no PC, and BTM changes. Cut-off values of BTMs were calculated based on least significant change (LSC) and also on underrunning median values of the untreated osteopenic postmenopausal reference group with a recent fracture. RESULTS: Out of 119 patients, 93 (78%) completed 12 months follow-up (45 PC and 48 no PC). Mean age was 69 years. Persistence was similar in PC and no PC participants. The cut-off value > 29% (< 415 ng/L) as LSC of s-CTX and > 36% (< 53.1 µg/L) as LSC of P1NP was determined optimally showing alendronate persistence after 1 year (being 93 and 88%, respectively). CONCLUSIONS: In this context, telephone calls did not improve persistence. In around 90% of patients, 1-year alendronate persistence was confirmed by achieving LSC of s-CTX and of P1NP at 12 months.

[Securing the distribution of patient-specific unit dose medication following the installation of a unit dose dispensing system: Cartography of risks a priori within a hospital pharmacy]. / Sécurisation de la dispensation individuelle et nominative suite à l'implantation d'un automate de dispensation nominative : cartographie des risques a priori au sein d'une pharmacie à usage intérieur.

INTRODUCTION: With a view to reinforcing the security of the drug distribution process, the hospital pharmacy has decided to automate the patient-specific unit dose distribution system which, up to now was performed manually, through the acquisition of a unit dose dispensing system: the ACCED S 300 (ECODEX®). The aim of this work is to realize a cartography of risks, focused on the dispensing stage, prior to the implementation of the automated system. MATERIALS AND METHOD: A multidisciplinary group applied the preliminary risk analysis (PRA) technique. The study was limited to the dispensing stage of unit doses within the hospital pharmacy. RESULTS: This analysis revealed 122 accident scenarii, including 18 with an initial unacceptable criticality (14.8 % of scenarii). In total, 140 risk management actions were proposed. These actions include: acquisition of equipment, communication and training of pharmacy staff, communication with services, human resources management and organization of working hours, writing and updating quality documents, programming the software and interfaces linked with the robot. CONCLUSION: The implementation of risk management actions should reduce the risk and contribute to avoiding the most critical scenarii. This will require the availability of human and financial resources and the implication of management.

Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013.

OBJECTIVES: To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique. METHODS: Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011-2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment. RESULTS: Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22-42%), 28% (CI: 17-40%) or 27% (CI: 7-50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs. CONCLUSIONS: Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs.

Suitability of Hair Testing in Medical Dispensing Errors: A Fatal Case of Gliclazide Poisoning.

A patient was prescribed a new treatment, 40 mg furosemide. Her pharmacist mistakenly dispensed 40 mg gliclazide instead. After 3 weeks of treatment, the patient was found in a coma, was hospitalised and died after a week. Hair sample was collected during post-mortem examination and tested for gliclazide on three 2 cm sections, starting at the root end. Hair strands were decontaminated, segmented and incubated in the presence of diazepam-d5, and a solid-liquid extraction has been performed. Finally, toxicological analyses were performed by UFLC Shimadzu Prominence - MS/MS Sciex 6500 QTRAP. Gliclazide was found on the proximal (238 pg/mg), median (77 pg/mg) and distal (69 pg/mg) segments. The concentration in the proximal segment was largely higher than in the other two, which demonstrates repeated intake of gliclazide by the patient during at least the last 2 months before death. The lower concentrations in the medial and distal segments, as well as a part of the concentration in the proximal segment, may be linked to external hair contamination. These could be due to either radial sweat diffusion, possibly occurring in the last week hospitalisation of the patient, or to biological fluids contamination during post-mortem examination. This case illustrates the opportunity to confirm slow and fatal chronic poisoning by gliclazide using hair analysis and shows the benefit of hair testing for the investigation of medical or dispensing errors.

Statins use amidst the pandemic: prescribing, dispensing, adherence, persistence, and correlation with COVID-19 statistics in nationwide real-world data from Poland.

Background: Adherence to medications presents a significant challenge in healthcare. Statins, used in primary and secondary prevention of cardiovascular disease, are of particular importance for public health. The outbreak of the COVID-19 pandemic resulted in additional healthcare system-related barriers impeding the execution of therapies. This study aimed to assess the use of as well as adherence and persistence to statins in a national cohort of 38 million of Polish citizens during pandemic. Methods: A retrospective analysis of prescription and dispensation data for all statins users from the national payer organization covering the years 2020-2022 was conducted. Medication adherence was assessed using the Medication Possession Ratio, for persistence the 30-day cut-off was accepted. National data on COVID-19 cases and COVID-19 related deaths were obtained from ECDC. Results: The analysis identified 7,189,716 Polish citizens (approximately 19% of Polish population) who were dispensed at least 1 pack of statins within the study period. Over that time, there was a continuous significant increasing trend in prescribing and dispensing of statins. Despite a total increase of 18.9% in the number of prescribed tablets, the percentage of tablets dispensed remained similar, averaging 86%. Overall percentage of adherent patients was 48.2%. For a random sample of 100,000 patients, the mean period of continuous therapy in 2022 was 6.2+/- 5.3 months. During the lockdown period, the mean number of prescribed and dispensed tablets was lower by 6.8% and 5.9%, respectively (p < 0.05). However, fluctuations in the number of COVID-19 cases or COVID-19-related deaths per week had no major impact on the prescribing and dispensing of statins. Conclusion: Over the time of pandemic, there was a continuous increase in the number of statin tablets prescribed and dispensed in Poland. This suggests that, despite the potential limitations posed by COVID-19, access to statins remained easy, which may be attributed to the mass-scale implementation of the national e-prescription system. However, it is crucial to realise that approximately 1/7 of prescribed statin doses were never dispensed, and the overall levels of adherence and persistence were low. This underscores the necessity for concerted efforts to change this scenario in Poland.

Government policies on job satisfaction of radiographers in tertiary hospitals, Gauteng.

Background: The National Department of Health has different operational policies to monitor the performance of its employees and to reward them accordingly. These policies could have a direct bearing on job satisfaction and career advancement for radiographers employed by the public sector, as there are previous reports that show that these policies affect the job satisfaction of other healthcare professionals negatively. Aim: The aim of the study was to explore the influence of government policies on the job satisfaction of radiographers employed by public tertiary hospitals in the Gauteng province. Setting: The study was conducted in two public tertiary hospitals in the Gauteng province. Methods: The study used a primary exploratory qualitative research design, with a purposive sampling technique. Data were collected through individual and focus group interviews. The researcher recorded and transcribed the interviews. Thematic analysis was used to analyse the data. Results: Three government policies had a negative impact on job satisfaction for radiographers. These were the Occupational Specific Dispensation (OSD), the Performance Management and Development System (PMDS) and the Employment Equity Act (EEA). The failure to effectively implement these policies also had a negative bearing on career pathing. Conclusion: The implementation and structure of these three government policies have resulted in job dissatisfaction amongst radiographers employed by public tertiary hospitals and reduced the structure of career pathing. Contribution: The study highlighted three government policies that negatively affect job satisfaction in Gauteng.