Editorial: Social and Administrative Policy in Healthcare and Pharmacy Practice

Most public health policies and activities in developing and developed countries are government-funded, so new information should be open to the public (1). There is a need to focus on both strengths and weaknesses of medication use policy, medication marketing, and evaluation of theoretical models. Furthermore, these could impact practice and/or patient behavior in responses to the social, health, and environmental challenges providing both theoretical and empirical findings. Potential issues include but are not limited to medication products/programs/services, medication adherence, disease management, medication use policy, and medication marketing (2–4). Social and health issues related to delivering health care services, medical governance, medication management, and pharmaceutical management related to multilevel, multi-stakeholder, and multi-sectoral approaches to healthy and affected communities should be explored. It is noteworthy to criticize ethical issues related to medication products/programs/services, medication use policy, and medication marketing. The ideas relevant to the social policy and health policy-related concepts received contributions from health policymakers, academics, practitioners, and collaborators in other sectors whose work impacts social and administrative policy. They were the appropriate sources to discuss how policy and practice change over time, how it compares across the globe, and how it is realized at all levels, from international to local. Whilst focused on relevance to practice, it was understood that examining the theories and philosophies that underpin social and administrative policy was essential. It captured a diversity of opinions across a broad range of fields, from the traditional (medication adherence; disease management; medication use policy; medication marketing, etc.) to the new (big data, new technologies). This Research Topic provided a venue for health professionals in social and administrative policy disciplines with a specific interest in policy and practice to share their research findings and other Research Topics related to public health

Antibiotics dispensing for URTIs by community pharmacists and general medical practitioners in Penang, Malaysia: A comparative study using simulated patients

Background: In Malaysia, doctors in private clinics (often called dispensing doctors) are permitted to dispense medicines. This potentially may compromise rational dispensing of medicines in general and antibiotics in particular. Aim: This study explored, assessed and compared dispensing of antibiotics between Community Pharmacist (CP) and General Practitioners (GPs) regarding symptomatic diagnosis, antibiotic categories, adherence to therapeutic doses and promotion of generic antibiotics. Method: The study used trained Simulated Patients (SPs), who used a scenario of common cold symptoms at GP private clinics and community pharmacies to observe and explore the practice of antibiotics dispensing. The study was conducted within the period of May to September 2011 in Penang, Malaysia. The data was analysed using descriptive statistics, Chi-square and Fisher’s Exact Tests at alpha level of 0.05. Results: GPs dispensed more antibiotics than CPs (p= 0.001) for common cold symptoms. They dispensed more Amoxicillin (n = 14, 35%) than CPs (n = 11, 11%) (p < 0.001) and more Tetracycline (n = 3, 7.5%) while no CP dispensed this category (p = 0.022). On the other hand, CPs (n = 11, 11%) suggested brand antibiotics where as GPs dispensed only generic antibiotics (p < 0.001). Generally GPs comply better with the symptomatic diagnosis standard e.g. when asking SPs about the symptoms they had, all GPs (n = 40, 100%) complied better with this standard. Despite that, they dispensed more antibiotics (n = 26, 65%) than CPs (n = 29, 29%) (p = 0.001). GPs (n = 22, 55%) also are better than CPs (n = 16, 16%) in adherence to therapeutic doses (p< 0.001). Conclusion: Findings showed poor adherence to rational dispensing of antibiotics by both providers. Although, GPs adhere better to symptomatic diagnosis and therapeutic dosing of antibiotics than CPs, they unnecessarily prescribe and dispense more antibiotics for Upper respiratory tract infection (URTI) symptoms. Establishing prescription guidance and regulatory actions, especially for URTIs treatment, and separating of medication dispensing are seemed to be crucial steps for the reform.Scopu

Prostate-Specific Antigen Levels Among Diabetic Men: Exploring Patients Attending Outpatient Clinic in Yemen

Introduction: It has been reported that patients with diabetes have a decreased risk for developing prostate cancer. The study aimed to measure Prostate-specific antigen (PSA) levels among diabetic men who had not previously been diagnosed with prostate cancer. Materials and Methods: A cross-sectional study was carried out in public hospitals among diabetic men in Aden, Yemen. A predesigned structured questionnaire, including the personal data as well as physical and clinical characteristics of the study population, such as height, weight, smoking status, the duration of diabetes, and the type of treatment, was included. Blood samples were collected from the respondents, and the levels of fasting blood glucose (FBG) and PSA were measured. The data were analyzed using descriptive and inferential statistics. Results: A total of 145 diabetic male patients were included in this study. The mean PSA level of the respondents was 2.56 ng/ml. There were significant differences in PSA levels according to patient age (p=0.000). The elderly patients exhibited significantly higher PSA levels than the younger groups. The PSA levels&nbsp;of&nbsp;smokers&nbsp;(2.60±0.48 ng/ml) were significantly&nbsp;higher (p=0.035) than those of nonsmokers (2.45±0.65 ng/ml). However, no significant difference was found in PSA levels according to body mass index (BMI) category, the type of treatment, or the duration of diabetes. Additionally, our results showed that PSA levels were not significantly correlated with FBG levels. Conclusion: PSA levels were associated with age and smoking status, but not with BMI, the type of diabetic treatment, the duration of diabetes, or with FBG levels

Evaluation of angiotensin II receptor blockers for drug formulary using objective scoring analytical tool

Drug selection methods with scores have been developed and used worldwide for formulary purposes. These tools focus on the way in which the products are differentiated from each other within the same therapeutic class. Scoring Analytical Tool (SAT) is designed based on the same principle with score and is able to assist formulary committee members in evaluating drugs either to add or delete in a more structured, consistent and reproducible manner. Objective: To develop an objective SAT to facilitate evaluation of drug selection for formulary listing purposes. Methods: A cross-sectional survey was carried out. The proposed SAT was developed to evaluate the drugs according to pre-set criteria and sub-criteria that were matched to the diseases concerned and scores were then assigned based on their relative importance. The main criteria under consideration were safety, quality, cost and efficacy. All these were converted to questionnaires format. Data and information were collected through self-administered questionnaires that were distributed to medical doctors and specialists from the established public hospitals. A convenient sample of 167 doctors (specialists and non-specialists) were taken from various disciplines in the outpatient clinics such as Medical, Nephrology and Cardiology units who prescribed ARBs hypertensive drugs to patients. They were given a duration of 4 weeks to answer the questionnaires at their convenience. One way ANOVA, Kruskal Wallis and post hoc comparison tests were carried out at alpha level 0.05. Results: Statistical analysis showed that the descending order of ARBs preference was Telmisartan or Irbesartan or Losartan, Valsartan or Candesartan, Olmesartan and lastly Eprosartan. The most cost saving ARBs for hypertension in public hospitals was Irbesartan. Conclusion: SAT is a tool which can be used to reduce the number of drugs and retained the most therapeutically appropriate drugs in the formulary, to determine most cost saving drugs and has the potential to complement the conventional method of drug selection as it is effective in aiding decision making process through the pre-established criteria and increasing scientific ground of decisions and transparency.Scopu

Letter to editor: Familiarisation of children with medicines and their sources of information

Scopu

Pharmaceutical pricing policies in Qatar and Lebanon: narrative review and document analysis

Objectives: This study aimed at reviewing and analysing the pharmaceutical pricing policies implemented in two middle-east countries. Methods: Official documents related to national pharmaceutical pricing policies were reviewed, and meetings with key informants in the registration and pricing departments in the Qatari and Lebanese ministries of public health were conducted. Key findings: As of April 2017, the laws currently in effect in Qatar and Lebanon are based on the latest versions of decrees enacted in 2011 and 2005 respectively. Both countries have implemented similar pharmaceutical pricing policies which apply only to the private sectors in both countries. Landing price in Lebanon is either free-on-board (FOB) or cost-insurance-freight (CIF) while it is only CIF in Qatar. External reference pricing and mark-up regulations were two of the common policies identified in both countries. For external reference pricing, the basket of countries considered and the price adopted were different. Mark-ups were applied with different schemes along the pharmaceutical supply chain in each country with Qatar imposing an overall higher mark-up margin. Moreover, Qatar utilized health technology assessment whenever such economic evaluation studies were available at the time of medicine registration. These pricing strategies applied to both public and private sectors in Lebanon, while they only applied to the private sector in Qatar. Conclusions: The pharmaceutical pricing policies implemented in Qatar and Lebanon are reflective of both the advancements in the human capital and financial resources of the nations and are in line with the World Health Organization-recommended pricing policies for developing countries.This work was supported by Qatar University [QUST-CPH-SPR-15/16-7 and QUST-CPH-SPR\2017-18].Scopu

Childhood Diarrhoea in Nepal

Diarrhoea is a leading cause of childhood morbidity and mortality in Nepal, a developing country where the larger proportion of the population live in rural areas. Poverty, illiteracy, lack of health care facilities at local level, demographical distribution and traditional beliefs are the major obstacles for getting proper and timely healthcare. There is a necessity to consider the cultural beliefs of different ethnic communities before designing any educational protocol or guideline. Educational protocol or guidelines which respect the local cultural beliefs and stimulate the utilization of their locally available facilities can be easily accepted and would be more suitable to achieve the objectives

Universal health coverage: the long road ahead for low- and middle-income regions

Universal health coverage (UHC) is one of the core Millennium Development Goals adopted in the United Nations and the World Health Organization’s (WHO) strategic agenda. Surprisingly, even as we approach the year 2021, achieving UHC to a reasonable extent and protecting the most vulnerable segments of native populations remains a challenge even for the richest of nations (1). In recent years, traditional world health sector establishments have assumed that most of the market demand for drugs, medical technologies, and services took place in rich Western societies, including Japan (2). Most of the market supply in terms of innovation and technology production led by multinational businesses, such as Big Pharma companies, also took place in these nations (3, 4). Back in 2000, WHO estimates on national health systems worldwide ranked the top ten systems, seven of which were European and only three of which were Asian (Japan, Oman, and Singapore) (5). Due to urbanization on a mega scale, however, growth in living standards and affordability of medical care and medicines can be seen throughout rapidly developing regions (primarily the BRIC nations (Brazil, Russia, India, China) and Southern and Eastern Asia) (6). In November 2018, a public announcement by the Chancellor of Germany, the largest EU economy, emphasized that most of the essential innovation in this area is now taking place either in North America or Far East Asia, far surpassing the European Union. All of these changes reflect heavily on the market demand for drugs, medicinal devices, services, and long-term care worldwide (7). Until the early 2000s, the global pharmaceutical market was still heavily dominated by the USA, representing approximately a 4% share of the global population and almost 50% consumption of brand-name medicines expressed in value-based turn over. Japan was ranked second in the same terms, preserving this position for a very long time. The contemporary pace of pharmaceutical innovation remains to be dominated by Western, Japanese, and Israeli-based multinationals (8). On the other hand, demand is exploding among emerging economies and all major investors are aware that the lion’s share of growth opportunities as we approach 2050 will take place in these emerging economies, outside of mature high-income Organization for Economic Co-operation and Development (OECD) member nations (10). Emerging markets, such as the BRIC nations or EM7 (BRIC + Indonesia, Mexico, and Turkey), remain the core focus of foreign capital investment in long-term strategies and forecasts (9).info:eu-repo/semantics/publishedVersio

A non-clinical randomised controlled trial to assess the impact of pharmaceutical care intervention on satisfaction level of newly diagnosed diabetes mellitus patients in a tertiary care teaching hospital in Nepal

Background Patient satisfaction is the ultimate goal of healthcare system which can be achieved from good patient-healthcare professional relationship and quality of healthcare services provided. Study was conducted to determine the baseline satisfaction level of newly diagnosed diabetics and to explore the impact of pharmaceutical care intervention on patients’ satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal. Methods An interventional, pre-post non-clinical randomised controlled study was designed among randomly distributed 162 [control group (n = 54), test 1 group (n = 54) and test 2 group (n = 54)] newly diagnosed diabetes mellitus patients by consecutive sampling method for 18 months. Diabetes Patient Satisfaction Questionnaire was used to evaluate patient’s satisfaction scores at baseline, three, six, nine and, twelve months’ follow-ups. Test groups patients were provided pharmaceutical care whereas control group patients only received their usual care from physician/nurses. The responses were entered in SPSS version 16. Data distribution was not normal on Kolmogorov-Smirnov test. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences among the groups before and after the intervention (p ≤0.05). Results There were significant (p < 0.001) improvements in patients’ satisfaction scores in the test groups on Friedman test. Mann-Whitney U test identified the significant differences in satisfaction scores between test 1 and test 2 groups, control and test 1 groups and, control and test 2 groups at 3-months (p = 0.008), (p < 0.001) and (p < 0.001), 6-months (p = 0.010), (p < 0.001) and (p < 0.001), 9-months (p < 0.001), (p < 0.001) and (p < 0.001) and, 12-months (p < 0.001), (p < 0.001) and (p < 0.001) follow-ups respectively. Conclusion Pharmaceutical care intervention significantly improved the satisfaction level of diabetics in the test groups compare to the control group. Diabetic kit demonstration strengthened the satisfaction level among the test 2 group patients. Therefore, pharmacist can act as a counsellor through pharmaceutical care program and assist the patients in managing their disease. This will not only modify the patients’ related outcomes and their level of satisfaction but also improve the healthcare system

Cost evaluation of therapeutic drug monitoring of gentamicin at a teaching hospital in Malaysia

Background: Therapeutic drug monitoring (TDM) makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin. Objective: In this study, we evaluated the costs associated with providing the service in patients with bronchopneumonia and treated with gentamicin. Methods: We retrospectively collected data from medical records of patients admitted to the Hospital Universiti Sains Malaysia over a 5-year period. These patients were diagnosed with bronchopneumonia and were on gentamicin as part of their treatment. Five hospitalisation costs were calculated; (i) cost of laboratory and clinical investigations, (ii) cost associated with each gentamicin dose, (iii) fixed and operating costs of TDM service, (iv) cost of providing medical care, and (v) cost of hospital stay during gentamicin treatment. Results: There were 1920 patients admitted with bronchopneumonia of which 67 (3.5%) had TDM service for gentamicin. Seventy-three percent (49/67) patients were eligible for final analysis. The duration of gentamicin therapy ranged from 3 to 15 days. The cost of providing one gentamicin assay was MYR25, and the average cost of TDM service for each patient was MYR104. The average total hospitalisation cost during gentamicin treatment for each patient was MYR442 (1EUR approx. MYR4.02). Conclusion: Based on the hospital perspective, in patients with bronchopneumonia and treated with gentamicin, the provision of TDM service contributes to less than 25% of the total cost of hospitalization