Prospective analysis of the medicine possession ratio of antidepressants in the private health sector of South Africa, 2006 - 2011

Background. Major depressive disorder (MDD) is a disabling mental illness with high morbidity and mortality rates. Inadequate treatment efficacy, unfavourable side-effect profiles and consequent shortfalls in compliance are major stumbling blocks in its treatment. Non-compliance data in low- to middle-income countries are lacking.Objective. To investigate the prevalence of antidepressant (AD) non-compliance in the private healthcare sector of South Africa (SA).Methods. We conducted a prospective cohort study analysing AD medicine claims (N=35 175) for 14 135 patients, obtained from a nationally representative pharmaceutical benefit management company, over a 6-year study period (1 January 2006 - 31 December 2011). The medicine possession ratio (MPR) was used as a proxy to determine compliance with AD medication. Only patients >18 years of age whose treatment had been initiated by a psychiatrist following an appropriate International Classification of Diseases (10th edition) (ICD-10) diagnosis of a mood disorder were included. A patient was considered compliant if the MPR was between ≥80% and ≤110% over a >4-month treatment period.Results. After the first 4 months, only 34% of patients were compliant. A statistically significant association was found between active ingredient consumed and compliance (p<0.0001). Only 26.2% of patients who received amitriptyline-containing products were compliant, compared with 38.8% and 38.7% for venlafaxine and duloxetine, respectively.Conclusion. Compliance data collected from pharmacy claims provide a workable estimate of the broader clinical scenario they represent. Although differences between classes of AD were evident, non-compliance was found to be high in the private healthcare environment of SA, comparable with global trends

Talion: A tragedy

Talion is a work of fiction which follows four characters - Freya, whose brother Ben has recently been killed; Slick, a young drug dealer; Abraham, a school teacher; and Nolwazi, a Pretoria police detective - as they deal with the aftermath of a shooting in which they are all involved. Told is short, punchy chapters, the novel follows Freya as she begins to stalk Abraham, who she identifies as her brother's killer, Nolwazi as she tries to solve Ben's murder, a case she cannot give her full attention to, Slick as he tries to maintain his criminality in an increasingly uncontrollable world and Abraham, who must deal with the trauma of his lost family and the desire to protect his only daughter, Sophie. Not a crime novel - Nolwazi will never know the full truth of the case she's been working - but a novel about those who commit crimes and solve them, Talion attempts to capture the dark and messy consequences of grief and revenge, while examining the isolating nature of anger. It is a novel about connections and disconnections, justice and injustice. The novel uses the city as its narrator, hopefully rendering a version of Pretoria not often seen in South African fiction. Written within the spirit of classic tragedy, the tightly controlled plot and heightened tension, as well as the brutal violence, strives to create something more than your average detective novel. A literary and genre hybrid that is both entertaining and unusual, suspenseful and complex

A cost benefit analysis in chronic medicine courier pharmacies : a case study

MBA, North-West University, Potchefstroom Campus, 2014The South African pharmaceutical market is seen as part of the so called "pharmerging" markets, together with countries like India, China and Brazil. These "pharmerging" markets are the fastest growing markets within the global pharmaceutical industry. The distribution of chronic medicine in South Africa is a growing market, as the disease burden in South Africa continues to escalate, with the incidence of chronic conditions growing at a rapid rate. The study will focus on one of South Africa’s pioneer courier medication service providers, with more than twenty years’ experience in the healthcare industry. The company will be referred to as Pharmacy X. The mission of Pharmacy X is to provide the right chronic medication, to the right patient, at the right place, at the right time. It is imperative to ensure that a patient receives his/her chronic medication on the scheduled date of delivery to ensure compliance and customer satisfaction. To achieve a competitive advantage, companies increasingly depend on their supply chain partners to minimize cost and improve business processes. The core value chain activity of outbound logistics has been outsourced by Pharmacy X to several courier companies. This study will aim to understand the importance of the outbound logistics function within the value chain of the company and the costs involved with the outsourcing of the function. The primary objective of this study was to determine the feasibility of an in-house courier operation in the Bloemfontein area versus the current outsourced courier model. In order to achieve the primary objective of the study, several secondary objectives were set and reached throughout the four chapters of this study. The study applied cost benefit analysis techniques to determine the feasibility of the Bloemfontein courier investment project. All the cost benefit analysis techniques concluded that the Bloemfontein courier investment will be a financial viable operation. The Bloemfontein courier investment will increase shareholder value over the period of the project compared to the current outsourced model. The contribution of this case study to determine the feasibility of a courier operation investment can be of value to Pharmacy X. The current projected total courier cost of Pharmacy X for the 2013 financial year amounts to more than a third of the total operational cost. The findings within the case study can lead to a greater national roll out of courier operations in order to reduce costs and increase profit margins for Pharmacy X.Master

Die ontwikkeling en vestiging van 'n klein distribusie-onderneming

Werkstuk (M. Com.) -- Universiteit van Stellenbosch, 1994.Een kopie mikrofiche.Full text to be digitised and attached to bibliographic record

Major depression and models for new generations effective antidepressants / Christiaan Beyers Brink

(Afrikaans follows English / Afrikaans volg Engels) Major depression is a severe mood disorder, affecting the lives of more than a hundred million people world-wide, including in Africa. Yet existing effective treatment options, including antidepressant drugs, are insufficient, prompting and leaving many challenges for research. Major depression is a multi-factorial disorder, affecting multiple systems of the body. Even when focusing only on the central nervous system (brain -as it is primarily a psychiatric disorder by definition), there is a multitude of neurobiological functions that are affected in this disorder. Consequently there are several hypotheses to explain the neurobiological basis of depression and antidepressant action, and many approaches are needed to study this complex disorder and its treatment. This overview focuses on various pre-clinical approaches and techniques in neuropsychopharmacological research, particularly those implemented by the author in his research. It will review recent data on the effects of antidepressants on monoamine receptor Signalling, the implementation of ozone inhalation by rats as a model to investigate the role of oxidative stress in antidepressant action, and on a 'bench-to-behaviour' approach to investigate novel targets for antidepressant action (specifically the role of modulators of cGMP signalling). Secondly, the overview discusses current needs for capacity building in neuropsychopharmacology on the African continent, and strategies to address these needs. It reviews initiatives and projects with which the author have been involved to promote the sciences on the African continent, referring to international, continental and national role players. While there are several success stories and hope shared, the need to assist Africa to help and to identify and support leaders in science, is highlighted. It is concluded that success in science ultimately lies in compassion with your fellowman. Key words: Depression; antidepressants; neuroplasticity; oxidative stress; ozone; receptor signalling; cGMP; African initiativ

Prospective analysis of the medicine possession ratio of antidepressants in the private health sector of South Africa, 2006-2011

Background: Major depressive disorder (MDD) is a disabling mental illness with high morbidity and mortality rates. Inadequate treatment efficacy, unfavourable side-effect profiles and consequent shortfalls in compliance are major stumbling blocks in its treatment. Noncompliance data in low- to middle-income countries are lacking. Objective. To investigate the prevalence of antidepressant (AD) non-compliance in the private healthcare sector of South Africa (SA). Methods: We conducted a prospective cohort study analysing AD medicine claims (N=35 175) for 14 135 patients, obtained from a nationally representative pharmaceutical benefit management company, over a 6-year study period (1 January 2006 - 31 December 2011). The medicine possession ratio (MPR) was used as a proxy to determine compliance with AD medication. Only patients >18 years of age whose treatment had been initiated by a psychiatrist following an appropriate International Classification of Diseases (10th edition) (ICD- 10) diagnosis of a mood disorder were included. A patient was considered compliant if the MPR was between ≥80% and ≤110% over a >4-month treatment period. Results: After the first 4 months, only 34% of patients were compliant. A statistically significant association was found between active ingredient consumed and compliance (p<0.0001). Only 26.2% of patients who received amitriptyline-containing products were compliant, compared with 38.8% and 38.7% for venlafaxine and duloxetine, respectively. Conclusion: Compliance data collected from pharmacy claims provide a workable estimate of the broader clinical scenario they represent. Although differences between classes of AD were evident, non-compliance was found to be high in the private healthcare environment of SA, comparable with global trendsNorth-West University, the National Research Foundation and the South African Medical Research Council, South Afric