A qualitative exploration of pharmacovigilance policy implementation in Jordan, Oman, and Kuwait using Matland’s ambiguity-conflict model

From Springer Nature via Jisc Publications RouterHistory: received 2021-04-06, accepted 2021-08-10, registration 2021-08-12, pub-electronic 2021-08-30, online 2021-08-30, collection 2021-12Publication status: PublishedFunder: Kuwait Ministry of Health; Grant(s): Kuwait Ministry of HealthAbstract: Background: As Arab countries seek to implement the ‘Guideline on Good Pharmacovigilance Practice (GVP) for Arab countries’, understanding policy implementation mechanisms and the factors impacting it can inform best implementation practice. This study aimed to explore the mechanisms of and factors influencing pharmacovigilance policy implementation in Arab countries with more established pharmacovigilance systems (Jordan, Oman), to inform policy implementation in a country with a nascent pharmacovigilance system (Kuwait). Results: Matland’s ambiguity-conflict model served to frame data analysis from 56 face-to-face interviews, which showed that policy ambiguity and conflict were low in Jordan and Oman, suggesting an “administrative implementation” pathway. In Kuwait, policy ambiguity was high while sentiments about policy conflict were varied, suggesting a mixture between “experimental implementation” and “symbolic implementation”. Factors reducing policy ambiguity in Jordan and Oman included: decision-makers’ guidance to implementors, stakeholder involvement in the policy’s development and implementation, training of policy implementors throughout the implementation process, clearly outlined policy goals and means, and presence of a strategic implementation plan with appropriate timelines as well as a monitoring mechanism. In contrast, policy ambiguity in Kuwait stemmed from the absence or lack of attention to these factors. Factors reducing policy conflict included: the policy’s compliance with internationally recognised standards and the policy’s fit with local capabilities (all three countries), decision-makers’ cooperation with and support of the national centre as well as stakeholders’ agreement on policy goals and means (Jordan and Oman) and adopting a stepwise approach to implementation (Jordan). Conclusions: Using Matland’s model, both the mechanism of and factors impacting successful pharmacovigilance policy implementation were identified. This informed recommendations for best implementation practice in Arab as well as other countries with nascent pharmacovigilance systems, including increased managerial engagement and support, greater stakeholder involvement in policy development and implementation, and undertaking more detailed implementation planning

Internationally trained pharmacists in Great Britain: what do registration data tell us about their recruitment?

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Removing Prescription Charges for Patients with Mental Health Disorders: Would it Improve Patient Outcomes in the UK?

The cost of copayments can deter patients from complying with essential medication. This can have a detrimental effect on health outcome and consequently healthcare costs. People with mental illness are commonly treated with regular and effective medication and are one group that is potentially vulnerable to these negative effects of copayments on compliance. Despite the existence of prescription charge exemptions in the UK, mental health disorders do not qualify for free prescriptions under the current list of chronic medical conditions. It has therefore been advocated by some that people with long-term mental health problems should receive exemption from prescription charges. Indeed, the existing evidence suggests that free medication would improve access, compliance and, consequently, health outcomes, which is also likely to result in savings of healthcare expenditure. However, simply adding mental health disorders to the list of chronic conditions qualifying for prescription charge exemption may not be the most appropriate way of achieving this. Despite alleviating the economic burden of people with mental health problems, such a move would leave other, equally deserving, chronic conditions excluded and would perpetuate the inequity of the current prescription charge exemptions. This article therefore suggests the need for a much more in-depth review of UK prescription charges and exemptions. It discusses possible ways of protecting vulnerable population groups against problems of medication cost and affordability, whilst taking the issue of limited National Health Service resources into account.Co-payment, Healthcare-expenditure, Prescribing, Psychiatric-disorders