Factors influencing access to pharmaceutical services in underserviced areas of the West Rand District, Gauteng Province, South Africa

The study examined demographic and socio-economic factors that may influence pharmaceutical services (PS) in underserviced communities of the West Rand District, Gauteng Province, South Africa. A quantitative survey was conducted using structured questionnaires administered to the general public (n = 2014) in Bekkersdal, Kagiso, Mohlakeng, Munsville and Diepsloot townships. The questionnaire explored demographic details, employment and education status, income levels, payment methods and convenience of services. Of the respondents, 54.0% were women, 52.0% were unemployed; 65.0% had secondary education or higher and > 70.0% had no income or earned < R1000 p.m. Unemployment was higher amongst women. Only 13.9% of respondents had medical aid membership, which influenced their choice of health provider, with the exception of pharmacy services which are not affected by medical aid membership. Medical aid members were, however, more able to pay. Employment status and education also influenced the choice of provider, with most of the employed (66.0%) and educated (64.4%) preferring a pharmacy or GP. On pharmacist gender, 47.5% of respondents had no preference, 27.6% preferred male pharmacists, whilst 24.9% preferred female pharmacists. Men with preferences preferred male providers (77.0%), whilst female respondents preferred female providers (69.3%). Respondents with no formal education and those with low or no income expressed higher gender preferences rates than those with formal education or higher income, respectively. Thus, access to PS was influenced by gender, age, family income and education level. Whilst medical aid membership had no influence on access to PS, it influenced ability to pay. These factors should be considered by those wishing to offer PS in such areas. Opsomming Toegang tot farmaseutiesedienste (FD) bly ‘n uitdaging in minderbevoorregte gebiede. Die huidige studie het demografiese- en sosio-ekonomiese faktore ondersoek, wat FD kan beϊnvloed in onder-bediende gemeenskappe van die Wes-Rand Distrik, Gauteng Provinsie, Suid-Afrika. Om te bepaal watter faktore toegang tot FD in vyf dorpsgebiede aan die Wes-Rand beïnvloed. Kwantitatiewe opnames met behulp van gestruktureerde vraelyste wat aan die algemene publiek (n = 2014) in Bekkersdal, Kagiso, Mohlakeng, Munsville, en Diepsloot dorpsgebiede uitgedeel is. Die vraelys het areas insluitende demografiese besonderhede, indiensneming- en opvoedingstatus, inkomstevlakke, metodes van betaling, en die gerief van die apteekdienste ondersoek. Daar was 2014 respondente (54.0% vroulik); 52.0% was werkloos; 65.0% het sekondêre of hoër onderwysopleiding; en > 70.0% het geen inkomste of verdien < R1000 p.m. Werkloosheid was hoër onder vroue, ongeag van vlak van opvoeding. Slegs 13.9% van die respondente het mediese fonds-lidmaatskap. Mediese fonds-lidmaatskap beïnvloed die keuse van gesondheidsverskaffer, maar toegang tot die apteekdienste is nie geraak deur mediese fonds-lidmaatskap nie. Mediese fondslede was egter meer in staat om te betaal. Die keuse van ‘n verskaffer is deur indiensneming- en opvoedingstaus beïnvloed, met die meeste van die respondente wat werksaam was (66.0%) en die meer opgevoedes (64.4%), wat ‘n apteker of ‘n algemene praktisyn verkies het. Ten opsigte van die apteker se geslag het 47.5% van die respondente geen voorkeur gehad nie, 27.6% het manlike aptekers verkies, terwyl 24.9% vroulike aptekers verkies het. Mans met voorkeure het manlike verskaffers verkies (77.0%), en vroulike respondente het vroulike verskaffers verkies (69.3%). Respondente met geen formele opleiding, en diegene met ‘n lae of geen inkomste het hoër geslagsvoorkeur resultate getoon. Toegang tot FD is beïnvloed deur geslag, ouderdom, gesinsinkomste en vlak van opvoeding. Mediese fonds-lidmaatskap daarenteen het geen beduidende invloed op die toegang tot FD gehad nie, maar wel op die vermoë om te betaal. Hierdie faktore moet in ag geneem word deur diegene wat belangstel om FD in soortgelyke gebiede te verskaf

Determining potential drug-drug interactions between lopinavir/ritonavir and other antiretrovirals and prescribed daily doses in a section of the private health care sector in South Africa

Lopinavir/ritonavir forms part of the antiretroviral therapy for the treatment of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The aim of this non-experimental, quantitative drug-utilization study was to determine and identify potential drug-drug interactions between lopinavir/ritonavir and other antiretrovirals in general practitioners and specialists prescriptions with inappropriate prescribed daily doses. The study was performed on 49,995 (2005), 81,096 (2006) and 88,988 (2007) anti-retroviral (ARV) prescriptions claimed through a pharmacy benefit management company. Of the total 2,638 ARV general practitioners prescriptions and 472 specialist’s prescriptions claimed with potential drug-drug interactions (DDIs), 505 (19.1%) were for general practitioners and 143 (30.3%) for specialists. Potential drug-drug interactions identified between lopinavir/ritonavir and other anti-retrovirals with inappropriate prescribed daily doses accounted for 88.9% (n = 449) for general practitioners and 98.6% (n = 141) for specialist’s prescriptions. The highest percentage of anti-retroviral prescriptions with potential drug-drug interactions were between lopinavir/ritonavir at 1066.4 mg/264 mg and efavirenz at 600 mg average of prescribed daily doses with 61.4% (n = 276) for general practitioners and 38.3% (n = 54) for specialists, prescribed to patients between 19 and 45 years. The recommended standard adult dose for lopivavir/ritonavir is 400 mg/100 mg twice daily or 800 mg/200 mg once daily. The dose prescribed to HIV/AIDS patients in this section of the private health care sector of South Africa was therefore high. It is therefore recommended that more education be given to prescribers and dosage adjustments be done where indicate

Further potential savings attributable to maximum generic substitution of antidepressants in South Africa: A retrospective analysis of medical claims

The main objective of the study was to calculate potential cost savings that could have been generated by maximum generic substitution of antidepressants within the private health care sector of South Africa from 2004 to 2006. Data on computerised medicine claims of patients receiving one or more antidepressants during three consecutive years (i.e. 2004, 2005 and 2006) were elicited from a South African pharmaceutical benefit management company. The total study population consisted of 292 071 items (N = 5 982 869) on 273 673 prescriptions (N = 5 213 765) at a total cost of R56 183 697.91(N = R1 346 210 929.00). A quantitative, retrospective drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Potential cost savings were computed for criteria-eligible substances in the study population. Generic medicine constituted 58.7% (N = 292 071) of all antidepressants claimed, at a total cost of 28.2% (N = R1 346 210 929.00)of all incurred costs. With total substitution of the average price of all criteria-eligible innovators, a potential saving of 9.3% (N = R56 183 697.91) of the actual antidepressant cost over the study period was calculated. In developing countries with limited health care resources, generic medicines can be cost-saving treatment alternatives. Opsomming Die hoofmikpunt van hierdie studie was om die potensiële kostebesparing te bereken wat deur maksimale generiese vervanging van antidepressante in die Suid-Afrikaanse private gesondheidsorgsektor tussen 2004 en 2006 teweeggebring sou kon word. Data oor gerekenariseerde eise vir medisyne van pasiënte wat een of meer antidepressante gedurende die studietydperk ontvang het (d.i. 2004, 2005 en 2006) is van ʼn Suid-Afrikaanse maatskappy wat farmaseutiese voordele bestuur, verkry. Die totale studiepopulasie het bestaan uit 292 071 items (N = 5 982 869)van 273 673 voorskrifte (N = 5 213 765) teen ʼn totale koste van R56 183 697.91 (N = R1 346 210 929.00).’n Kwantitatiewe, retrospektiewe medisyneverbruiksontleding is gedoen en data is geanaliseer deur van die Statistical Analysis System®-pakket gebruik te maak. Potensiële kostebesparings is vir middels in die studiepopulasie wat aan die kriteria voldoen het, bereken. Generiese produkte het 58.7% (N = 292 071) van alle produkte wat voorgeskryf is, uitgemaak, teen ʼn totale koste van 28.2% (N= R1 346 210 929.00). Indien die gemiddelde prys van alle middels wat aan die kriteria vir vervanging voldoen het, met die prys vir generiese middels vervang word, is ʼn potensiële besparing van 9.3%(N = R56 183 697.91) van die werklike koste vir antidepressante gedurende die studietydperk moontlik. Generiese middels kan in ontwikkelende lande met beperkte gesondheidsorg-hulpbronne kostebesparende alternatiewe wees