The 2001 National Pharmacy Consumer Survey

Objectives To determine the types of pharmacy services used by consumers, to determine what sources they accessed for information on health and prescription drugs, and to assess their satisfaction with these information sources. Design Telephone survey. Setting Households. Participants Random sample of 1,201 consumers who reported having used the Internet during the previous 2 months and having filled at least one prescription within the past 6 months. Results Convenience continues to be the primary patronage motive for using a particular pharmacy, followed by price and service. Satisfaction with pharmacy services remains high, with 85% of respondents reporting being satisfied with the process of filling a new prescription and 90% being satisfied with the refill process. Exploratory analyses showed that respondents who reported they always asked questions of their pharmacists were consistently more satisfied with pharmacy services. Consumers ranked physicians and pharmacists as the first and second most important sources for drug information, and they were more satisfied with information obtained from these sources than they were with information obtained from print or electronic information sources. Thirty-six percent of respondents had searched the Internet for information on prescription medications within the past year. Conclusion Convenience is still the primary determinant of pharmacy selection, and most consumers continue to use a single pharmacy. Exploratory analysis suggests a direct association between active information seeking from the pharmacist and consumers’ satisfaction with pharmacy services

Safety, tolerability and efficacy of repeated doses of dihydroartemisinin-piperaquine for the prevention and treatment of malaria: A systematic review and meta-analysis

Background Intermittent preventive treatment (IPT) for malaria is used in infants, children, adults and pregnant women. Dihydroartemisinin-piperaquine (DP) is an effective, well tolerated artemisinin-based combination therapy. The long half-life of piperaquine makes it attractive for IPT. We conducted a systematic review and meta-analysis to determine the efficacy and safety of repeated treatment with DP. Methods Following PRISMA guidelines, we searched multiple databases on September 1, 2016 with the terms: “human” AND “dihydroartemisinin-piperaquine” OR “DHA-PPQ.”. Prospective studies of IPT-DP or repeat DP courses for case-management were eligible. Random effects models were used. Findings Eleven studies were included: two repeat treatment studies (one in children <5y and one in pregnant women), and nine IPT trials (five in children <5y; one in schoolchildren; one in adults; two in pregnant women). Comparator interventions included placebo, artemether-lumefantrine, sulfadoxine-pyrimethamine (SP), SP-amodiaquine, SP-piperaquine, SP-chloroquine, and trimethoprim-sulfamethoxazole. Of 14,628 participants, 3,935 received multiple DP courses (2-18). Monthly IPT-DP was associated with an 84% reduction in the incidence of malaria parasitaemia measured by microscopy compared to placebo. Monthly IPT-DP was associated with fewer serious adverse events than placebo, daily trimethoprim-sulfamethoxazole, or monthly SP. Among 56 IPT-DP recipients (26 children, 30 pregnant women), all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP. Interpretation Monthly DP appears well-tolerated and effective for IPT. Additional data are needed in pregnancy and to further explore the cardiac safety with monthly dosing. Funding Source Bill & Melinda Gates Foundation and NI

Effect of tenofovir containing ART on renal function in patients with moderate/severe reduced creatinine clearance at baseline : a retrospective study at two referral hospitals in Namibia

Prescription of tenofovir disoproxil fumarate (TDF) for patients with baseline creatinine clearances (CrCl) <60ml/min is said to increase risk of further decline in CrCl. Study objectives were to assess incidence of improvement and predictors thereof; to assess incidence of decline and transition to lower stages of CrCl; and comparison of declines between patients with a baseline CrCl <60ml/min (group-I) and ≥60ml/min (group-II). The study was retrospective, included patients 16yrs or older who received TDF-containing ART. Improvement and decline were defined as ≥25% increase or decrease in CrCl, respectively. Binary logistic regression was performed to identify predictors of improvement. Groups I and II had 2861 and 7526 patients, respectively. In group-I, improvement in CrCl was observed in 40.1% (n=1,146), and was associated with stage IV of CrCl (adjusted Odds Ratio [aOR]=13.4 [95%CI: 6.7 – 26.9, p<0.001]); male gender (aHR=1.8 [95%CI: 1.5 – 2.2, p<0.001]); and a poor HIV-status (aHR=1.2 [95%CI: 1.0 – 1.4], p=0.033). In groups-I and group-II, respectively, decline occurred in 2.3% and 13.0%, (p<0.001); transition to lower stages occurred in 1.0% and 25.2% (p<0.001); and migration to stage IV CrCl occurred in 1.0% and 0.5% (p<0.001). Improvement was more likely than decline in group-I patients. Although, group-I patients were more likely to experience new onset severe reduced CrCl than group-II patients, the proportions were extremely low. TDF should not be withheld from HIV-positive patients with a baseline CrCl <60ml/mi

Availability and Prices of Antimalarials and Staffing Levels in Health Facilities in Embu County, Kenya

Effective treatment of malaria relies on the availability of quality medicines while pricing is a major determinant of affordability. In addition, adequate numbers of competent staff of different cadres is essential for a well-functioning health system and effective health service delivery. The aim of the study was to determine the availability and prices of antimalarial medicines as well as staffing levels in healthcare facilities located in Embu County, Kenya. Antimalarials were sampled from 11 public (government owned) facilities, 29 private pharmacies, 5 private-for-profit and 3 not-for-profit mission health facilities in May-June 2014. The majority of public facilities (91%) had artemether-lumefantrine (AL) tablets in stock. Government and mission facilities did not stock second line antimalarials or sulfonamide-pyrimethamine (SP). All public facilities provided antimalarials free-of-charge to patients. Private pharmacies stocked a wider variety of antimalarials. The facilities studied were stocked with recommended antimalarials both in the private and public domains. No oral artemisinin monotherapies were encountered during the study. Only 45% percent of public facilities employed pharmacists. Of the remaining facilities, 27% employed pharmaceutical technologists while in the rest of the facilities pharmaceuticals were in the custody of nurses. Notably, none of the private-for-profit or mission facilities had pharmacists employed in their establishments; one facility employed a pharmaceutical technologist, while the rest were staffed by nurses. The number of private pharmacies superintended by pharmacists and pharmaceutical technologists were 7 (24%) and 22 (76%), respectively.Key words: Antimalarials, artemisinin-based combination therapy, staffing level, Embu Count

The burden of disease in Greece, health loss, risk factors, and health nancing, 2000–16: an analysis of the Global Burden of Disease Study 2016

Background Following the economic crisis in Greece in 2010, the country's ongoing austerity measures include a substantial contraction of health-care expenditure, with reports of subsequent negative health consequences. A comprehensive evaluation of mortality and morbidity is required to understand the current challenges of public health in Greece. Methods We used the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to describe the patterns of death and disability among those living in Greece from 2000 to 2010 (pre-austerity) and 2010 to 2016 (post-austerity), and compared trends in health outcomes and health expenditure to those in Cyprus and western Europe. We estimated all-cause mortality from vital registration data, and we calculated cause-specific deaths and years of life lost. Age-standardised mortality rates were compared using the annualised rate of change (ARC). Mortality risk factors were assessed using a comparative risk assessment framework for 84 risk factors and clusters to calculative summary exposure values and population attributable fraction statistics. We assessed the association between trends in total, government, out-of-pocket, and prepaid public health expenditure and all-cause mortality with a segmented correlation analysis. Findings All-age mortality in Greece increased from 944·5 (95% uncertainty interval [UI] 923·1–964·5) deaths per 100 000 in 2000 to 997·8 (975·4–1018) in 2010 and 1174·9 (1107·4–1243·2) in 2016, with a higher ARC after 2010 and the introduction of austerity (2·72% [1·65 to 3·74] for 2010–16) than before (0·55% [0·24 to 0·85] for 2000–10) or in western Europe during the same period (0·86% [0·54 to 1·17]). Age-standardised reduction in ARC approximately halved from 2000–10 (−1·61 [95% UI −1·91 to −1·30]) to 2010–16 (−0·87% [–2·03 to 0·20]), with post-2010 ARC similar to that in Cyprus (−0·86% [–1·4 to −0·36]) and lower than in western Europe (−1·14% [–1·48 to −0·81]). Mortality changes in Greece coincided with a rapid decrease in government health expenditure, but also with aggregate population ageing from 2010 to 2016 that was faster than observed in Cyprus. Causes of death that increased were largely those that are responsive to health care. Comparable temporal and age patterns were noted for non-fatal health outcomes, with a somewhat faster rise in years lived with disability since 2010 in Greece compared with Cyprus and western Europe. Risk factor exposures, especially high body-mass index, smoking, and alcohol use, explained much of the mortality increase in Greek adults aged 15–49 years, but only explained a minority of that in adults older than 70 years. Interpretation The findings of increases in total deaths and accelerated population ageing call for specific focus from health policy makers to ensure the health-care system is equipped to meet the needs of the people in Greece

Tenofovir disoproxil fumarate associated nephrotoxicity : a retrospective cohort study at two referral hospitals in Namibia

Introduction: The incidence and risk factors of tenofovir disoproxil fumarate (TDF)-related renal impairment (RI) in Namibia are unknown where TDF-containing ART regimens are used as the first line for HIV. Methodology: A retrospective cohort study among HIV-infected patients at two intermediate hospitals. A decline in estimated glomerular filtration rate (eGFR) was significant if it was ≥25% and included a change to a lower eGFR stage. New-onset RI was defined as an eGFR 2.0, for decline-in-eGFR were baseline eGFR >60 (aHR = 15.6); hyperfiltration (aHR = 5.0); and pregnancy (aHR = 2.4); while for RI, they were hyperfiltration (aHR = 4.1) and pregnancy (aHR = 29). Conclusion: The incidence of decline-in-eGFR was higher than in other sub-SSA countries, but not RI. A high baseline eGFR had the greatest risk for the decline, and hyperfiltration for the RI

Estimating the costs of induced abortion in Uganda: A model-based analysis

<p>Abstract</p> <p>Background</p> <p>The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. These abortions, which are usually unsafe, lead to a high rate of severe complications and use of substantial, scarce healthcare resources. This study was performed to estimate the costs associated with induced abortions in Uganda.</p> <p>Methods</p> <p>A decision tree was developed to represent the consequences of induced abortion and estimate the costs of an average case. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Societal costs, direct medical costs, direct non-medical costs, indirect (productivity) costs, costs to patients, and costs to the government were estimated. Monte Carlo simulation was used to account for uncertainty.</p> <p>Results</p> <p>The average societal cost per induced abortion (95% credibility range) was $177 ($140-$223). This is equivalent to$64 million in annual national costs. Of this, the average direct medical cost was $65 ($49-86) and the average direct non-medical cost was $19 ($16-$23). The average indirect cost was$92 ($57-$139). Patients incurred $62 ($46-$83) on average while government incurred$14 ($10-$20) on average.</p> <p>Conclusion</p> <p>Induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers--that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical.</p