Drug utilisation studies on the impact of the reduction of the prescription charge in Wales and the reclassification of medicines

Since 2000 there have been a number of policy changes in the UK to remove barriers that limit access to medicines. Perhaps the most significant of these have been the phased reduction and abolition of the prescription charge in Wales and the efforts of the UK Government to encourage the reclassification of medicines. This thesis explored aspects of both these changes. The percent change in the number of prescription items dispensed over the two year period before and after the first reduction of the prescription charge in October 2004 was determined. There was an increase in the percent change median interquartile range for non-sedating antihistamines 7.3 5.0 - 10.7 to 13.7 10.9 - 17.1, p=0.001 and laxatives 2.2 0.8 - 3.1 to 3.7 1.4 - 6.4, p=0.04, whilst no change was observed for loperamide -1.2 -3.3 - 3.2 to 2.6 -0.9 - 5.2, p 0.11 and fluconazole -7.4 -14.4 - 2.1 to -3.7 -10.9 - 1.4, p=0.52. Over the counter OTC sales of omeprazole and simvastatin were monitored following reclassification and accounted for less than 1 of the volume of their prescription counterpart. In contrast, sales of OTC hyoscine butylbromide and chloramphenicol eye drops were more than 20 of the number of items dispensed. Twelve months after reclassification there was an increase in the percent change in the number of prescription items dispensed for hyoscine butylbromide in Wales 5.8 0.2 - 12.6 to 20.7 4.4 - 25.6, p=0.007, whilst prescriptions for chloramphenicol eye drops decreased 10.0 6.0 - 13.6 to -8.9 -13.1 - -4.4, p=0.001. More OTC chloramphenicol was sold in less deprived areas r=-0.44, p=0.04. The changes in prescription volume and OTC medicine sales varied from medicine to medicine and require a qualitative evaluation to better understand the reasons behind the differences observed

Drug utilisation studies on the impact of the reduction of the prescription charge in Wales and the reclassification of medicines

Since 2000 there have been a number of policy changes in the UK to remove barriers that limit access to medicines. Perhaps the most significant of these have been the phased reduction and abolition of the prescription charge in Wales and the efforts of the UK Government to encourage the reclassification of medicines. This thesis explored aspects of both these changes. The percent change in the number of prescription items dispensed over the two year period before and after the first reduction of the prescription charge in October 2004 was determined. There was an increase in the percent change median interquartile range for non-sedating antihistamines 7.3 5.0 - 10.7 to 13.7 10.9 - 17.1, p=0.001 and laxatives 2.2 0.8 - 3.1 to 3.7 1.4 - 6.4, p=0.04, whilst no change was observed for loperamide -1.2 -3.3 - 3.2 to 2.6 -0.9 - 5.2, p 0.11 and fluconazole -7.4 -14.4 - 2.1 to -3.7 -10.9 - 1.4, p=0.52. Over the counter OTC sales of omeprazole and simvastatin were monitored following reclassification and accounted for less than 1 of the volume of their prescription counterpart. In contrast, sales of OTC hyoscine butylbromide and chloramphenicol eye drops were more than 20 of the number of items dispensed. Twelve months after reclassification there was an increase in the percent change in the number of prescription items dispensed for hyoscine butylbromide in Wales 5.8 0.2 - 12.6 to 20.7 4.4 - 25.6, p=0.007, whilst prescriptions for chloramphenicol eye drops decreased 10.0 6.0 - 13.6 to -8.9 -13.1 - -4.4, p=0.001. More OTC chloramphenicol was sold in less deprived areas r=-0.44, p=0.04. The changes in prescription volume and OTC medicine sales varied from medicine to medicine and require a qualitative evaluation to better understand the reasons behind the differences observed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Inequalities in access to medications among people diagnosed with diabetes inlow- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death.To assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs.We conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases - PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE - was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others).Fifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications.The review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs

How diabetes risk assessment tools are implemented in practice: A systematic review

This review aimed to explore the extent of the use of diabetes risk assessment tools and to determine influential variables associated with the implementation of these tools. CINAHL, Google Scholar, ISI Citation Indexes, PubMed, and Scopus were searched from inception to January 2013. Studies that reported the use of diabetes risk assessment tools to identify individuals at risk of diabetes were included. Of the 1719 articles identified, 24 were included. Follow-up of high risk individuals for diagnosis of diabetes was conducted in 5 studies. Barriers to the uptake of diabetes risk assessment tools by healthcare practitioners included (1) attitudes toward the tools; (2) impracticality of using the tools and (3) lack of reimbursement and regulatory support. Individuals were reluctant to undertake self-assessment of diabetes risk due to (1) lack of perceived severity of type 2 diabetes; (2) impracticality of the tools; and (3) concerns related to finding out the results. The current use of non-invasive diabetes risk assessment scores as screening tools appears to be limited. Practical follow up systems as well as strategies to address other barriers to the implementation of diabetes risk assessment tools are essential and need to be developed

Safety of nortriptyline at equivalent therapeutic doses for smoking cessation: a systematic review and meta-analysis

Background: The limited use of nortriptyline for smoking cessation is likely due to concerns about its serious adverse effects. Objective: To examine the safety of nortriptyline at doses equivalent to those used in aiding smoking cessation. Data Sources: A systematic search of relevant articles inMEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, PsychINFO,WHO publications and the Clinical Trials database (through November 2008). Study Selection: All studies of nortriptyline at doses between 75 and 100mg in any indication were reviewed. Data Extraction: The quality of included studies was assessed based on the Jadad score. Data were extracted using a data extraction form. Data Synthesis: From 442 potentially relevant articles identified, 17 studies met our selection criteria and were included for data analysis. Indications for nortriptyline in these studies were smoking cessation (eight studies), depression (five studies), neuropathic pain (three studies) and schizophrenia (one study). 2885 individuals participated in these studies, with exposure time ranging between 4 and 12 weeks. The major comparator used in these trials was placebo. Overall, no life-threatening events occurred in these studies. Orthostatic hypotension was significantly higher in nortriptyline users than in comparator groups (relative risk 2.8; 95% CI 1.4, 5.3). Other adverse events significantly associated with nortriptyline were anticholinergic-related effects including drowsiness, dizziness, gastrointestinal disturbance and dysgeusia. Conclusions: Current evidence suggests that nortriptyline, at doses between 75 and 100 mg, is not significantly associated with serious adverse events when administered in patients without underlying cardiovascular disease

Smoking cessation education in Thai schools of pharmacy

Pharmacy graduates are expected to have adequate training about smoking cessation. This study aimed to determine the extent of smoking cessation content provided in Thai pharmacy schools. A self-administered questionnaire was mailed to all pharmacy schools in Thailand. Head of schools were asked to distribute the questionnaire to faculty members who taught topics related to smoking cessation. Course descriptions in the current curriculum of all pharmacy undergraduate programs were reviewed. All 12 schools of pharmacy responded to the questionnaires. A median time spent on all topics was 198 minutes. The most heavily emphasized topics were health effects of smoking, counseling techniques, and smoking cessation aids. Main barriers were limited teaching time and a lack of clerkship sites focusing on smoking cessation services. Only one school has their course description contained the words related to smoking cessation. These findings suggested a more standardized and effective smoking cessation education for Thai pharmacy students

Clinical Outcomes of Telemonitoring for Patients on Warfarin after Discharge from Hospital

Objective. To evaluate the impact of telephone follow-up service on clinical outcomes in patients on warfarin when discharged from hospital. Methods. This randomized controlled trial was conducted at a general hospital in Thailand. Patients aged ≥20 years who were prescribed warfarin when discharged were eligible to participate in this study. They were randomly allocated, using a computer generated random number, to receive either telephone follow-up intervention or usual care. Participants in the intervention group received telephone follow-up by hospital pharmacists for three months. During each telephone call, pharmacists performed medicine use reviews and addressed any problems identified. Key Findings. A total of 50 patients participated in this study. The proportion of international normalized ratio (INR) values in the target range for the telephone follow-up group (36/79, 45.6%) was higher than that in the usual care group (19/79, 24.1%), p=0.005. The mean time in the therapeutic range (TTR) in the telephone follow-up group was also higher than that in the usual care group (49.8±34.3 versus 28.0±27.5, p=0.017). All patients in the usual care group experienced one or more out-of-range INR values (25/25, 100%) compared to 21 out of 25 (84%) in the telephone follow-up group, p=0.037. There was no difference between the two groups in the incidence of complications or adverse events associated with warfarin. Conclusions. The telephone follow-up service in recently discharged patients helps them achieve and maintain their INR target. This anticoagulant supportive service should be promoted to patients receiving warfarin therapy after discharge. This trial is registered with TCTR20180614006 (Thai Clinical Trials Registry)

Opportunistic screening and health promotion for type 2 diabetes: an expanding public health role for the community pharmacist

BackgroundEarly detection to identify people at risk of diabetes is an important approach to prevent or delay type 2 diabetes. This study aimed to implement the Diabetes Prevention Program in community pharmacy using a diabetes risk prediction tool.MethodsThe program was conducted in seven pharmacies in Bangkok, Thailand. Participants were the pharmacy's clients aged ≥35 years without the history of diabetes. A validated risk prediction tool was used to assess individuals' diabetes risk. Educational information was offered to all participants. Those with a high risk score (≥9 out of 17) were offered a self-check of fasting capillary blood glucose (CBG). A referral was made for those with CBG ≥126 mg/dl.ResultsDuring a 3-month service, 397 individuals participated in the program. Nearly half of the participants (49.4%) were at a high risk of diabetes (risk score: ≥9). Ninety five (48.5%) of these high risk individuals undertook fasting CBG. Elevated fasting CBG (≥126 mg/dl) was found in 12 persons (12.7%). Overall, two patients with diabetes were identified during the provision of the program.ConclusionsThe Diabetes Prevention Program in community pharmacies uncovered half of the clients who were at risk of diabetes and provided an opportunity for participants to learn more about the prevention of diabetes. © 201

Pharmacy practice in Thailand

Pharmacy education was established in Thailand in 1913 and gradually evolved to pharmaceutical care in recent decades. By the year 2014, all schools of pharmacy were required by the Pharmacy Council of Thailand to offer only a 6-year Doctor of Pharmacy (PharmD) program. The paradigm shift to the PharmD program and the implementation of a quality assurance system have tremendously influenced pharmacy practice in Thailand. Hospital pharmacists have become more involved in pharmacy education through preceptorships and are an integral part of inpatient and outpatient care teams. In community pharmacy practice, a number of services have recently been provided and are reimbursable, ranging from public health practice (i.e., health prevention/promotion) to advanced professional practice (e.g., medication use review). Challenges to Thai pharmacy practice include the distribution of pharmacists to meet the workforce demands. Evidence synthesis is needed to guide the implementation and course of Thai pharmacy practice in the future