Pharmacoeconomic considerations in the treatment of breast cancer

Breast cancer is the most common malignancy in women worldwide and causes great economic burden. The aim of this paper is to present the available clinical and pharmacoeconomic evidence associated with different therapies for breast cancer. As significant progress was made in recent years and there are many alternative treatments, which are indicated according to the stage and the type of the disease, the age and health status of patient, and vary from surgery to hormonal treatment and chemotherapy. A broad literature review was undertaken and the paper presents the evidence available regarding the effectiveness and cost-effectiveness of the alternative options. Despite the high cost of most therapies and perceptions that treatments in this area may not be cost-effective, due to a combination of high costs and short survival, based on the literature review treatment options for breast cancer are in general deemed to be cost-effective. Time horizon, stage of the disease, patient age, therapy onset, benefit duration and time to recurrence may influence the results. Pharmacoeconomic analyses of alternative therapy options will improve decision-making and will help to optimize the use of scarce health care resources allocated to the care of breast cancer patients

Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey

<p>Abstract</p> <p>Background</p> <p>Over the past few decades, drug and overall healthcare expenditure have risen rapidly in most countries. The present study investigates the attitudes and the factors which influence physician prescribing decisions and practice in Greece and Cyprus.</p> <p>Methods</p> <p>A postal questionnaire was developed by researchers at the Department of Health Economics at the National School of Public Health in Greece, specifically for the purposes of the study. This was then administered to a sample of 1,463 physicians in Greece and 240 physicians in Cyprus, stratified by sex, specialty and geographic region.</p> <p>Results</p> <p>The response rate was 82.3% in Greece and 80.4% in Cyprus. There were similarities but also many differences between the countries. Clinical effectiveness is the most important factor considered in drug prescription choice in both countries. Greek physicians were significantly more likely to take additional criteria under consideration, such as the drug form and recommended daily dose and the individual patient preferences. The list of main sources of information for physicians includes: peer-reviewed medical journals, medical textbooks, proceedings of conferences and pharmaceutical sales representatives. Only half of prescribers considered the cost carried by their patients. The majority of doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may not be excellent but it is acceptable. However, only Cypriot physicians actually prescribe them. Physicians believe that new drugs are not always better and their higher prices are not necessarily justified. Finally, doctors get information regarding adverse drug reactions primarily from the National Organisation for Medicines. However, it is notable that the majority of them do not inform the authorities on such reactions.</p> <p>Conclusion</p> <p>The present study highlights the attitudes and the factors influencing physician behaviour in the two countries and may be used for developing policies to improve their choices and hence to increase clinical and economic effectiveness and efficiency.</p

General practitioners' choice regarding prescribing

Introduction: Prescribing represents a fundamental component of patient care. Rational prescribing is crucial for patients' health and the health system. However, globally irrational prescribing is common and has a negative impact on clinical outcomes and the efficiency of health system. On the other hand, prescribing patterns determine the volume of pharmaceutical consumption and consequently pharmaceutical expenditure. However, in Greece there are only limited research evidence from specific health centers and there are no sufficient data neither for GPs' prescribing patterns in primary health care, nor for their beliefs regarding prescribing. Objectives: The aim of the present study was to record prescribing patterns of GPs and identify the specific prescribing circumstances in primary health care in Greece compared to other European countries. Furthermore, the present study aimed at identifying GPs' beliefs regarding prescribing.Methods: For this purpose a combination of qualitative and quantitative methods was used in order to capture and understand the different perspectives of GPs' prescribing behavior. At first, a qualitative study took place using the method of Focus Groups, and 19 GPs from 3 geographically defined regions in Greece participated. Discussions were recorded after participants' written informed consent and a directed content analysis was used, guided by the Theory of Planned Behavior in order to identify and classify GPs' salient beliefs regarding prescribing. The results from this qualitative study were used to inform the development of two (2) questionnaires. The aim of the first questionnaire was to record prescribing patterns of Greek GPs and was used in a prospective cross-sectional study that took place in Crete and in Athens. 13 GPs completed the questionnaire giving data for 1,202 patients and then specific prescribing rates were calculated. The second questionnaire was developed based on the TPB and the aim was to explore GPs' intention to prescribe medicines to a patient during a consultation in a primary care facility, and the antecedents of this intention. 699 GPs from 7 European countries (Cyprus, Czech Republic, France, Greece, Malta, Sweden and Turkey) participated.Results: GPs that participated in the qualitative study acknowledged that medicines are an important tool in clinical practice and that prescribing is the most important method for treating diseases in primary care. This finding was confirmed in the following stages of the research, since participated GPs actually prescribed medicines to the majority of their patients. The qualitative study also, revealed the specific circumstances that GPs face during prescribing in primary care. These phenomena were important barriers in prescription choice and were identified as: (a) prescribing through a third person, (b) repeat prescribing for chronic diseases without examination and (c) prescribing following patient's prescription request for prescribed medicines that they have already purchased over the counter through pharmacies. The aforementioned situations are phenomena of irrational prescribing and the present study confirmed that these constitute over 50% of the total prescriptions in Greece. These phenomena are also common in all countries, although in different extent. GPs from Sweden and Czech Republic were more reluctant to prescribe under these circumstances. In all countries GPs had a positive attitude towards prescribing and were in control of prescribing decision. GPs from Greece and Cyprus claimed to feel social pressure to prescribe. Especially, Greek GPs considered that prescribing had many advantages for patients' health and the health system as well. They acknowledged that there are also disadvantages regarding adverse drug reactions and increased cost for the patient because of the copaymets. Patients and their family were identified as the groups of people that place pressure on GPs to prescribe. Other groups that place pressure on GPs to prescribe but to a lesser extent are pharmaceutical sales representatives. Correct diagnosis, guidelines and the sufficient time to explain the use of medicines were considered to facilitate prescribing decision. On the other hand, special situations in prescribing (phenomena of irrational prescribing) and the limited time for consultation were identified as important barriers to prescribing. The present study also shed light to the needs of GPs regarding continuing education and their positive attitude towards guidelines, audit and their motivation to comply with the recommendations of the Public Health Authorities. GPs' prescribing intention was different in participating countries and GPs from Sweden and Malta were less inclined to prescribe. Correlations between TPB explanatory measures and prescribing intention were weak and TPB direct measures explained about 25% of variance in intention to prescribe in Malta and Czech Republic. Conclusions: The present study explored for the first time in Greece GPs' beliefs regarding prescribing using the theoretical model of the Theory of Planned Behavior, which was then applied in 7 European countries. The present study also, identified and measured the special situations in prescribing in primary care not only in Greece but in all participating countries. Furthermore, it was the first time that the special situation of prescribing for medicines already bought from pharmacy was identified and measured in Greece. The results of the present study show the prescribing is not always a rational decision, but it is subject to various beliefs and factors that are different in each country. Consequently, there is a need to improve prescribing and the present study shed light to the areas and situations that need to be addressed in future. Also, the aforementioned findings are expected to contribute to the better understanding of continuing education needs not only for GPs but for pharmacists and patients as well. Finally, these findings are expected to have an impact on designing of suitable policies towards rational prescribing and guiding future research.Εισαγωγή: Η συνταγογράφηση είναι μια από τις σημαντικότερες πράξεις στην ιατρική φροντίδα. Από τη μια πλευρά, η επίτευξη της ορθής συνταγογράφησης είναι καίριας σημασίας τόσο για τον ίδιο τον ασθενή όσο και για το σύστημα υγείας. Ωστόσο, διεθνώς καταγράφονται περιστατικά μη ορθής συνταγογράφησης τα οποία επηρεάζουν αρνητικά τις εκβάσεις υγείας του ασθενή και την αποδοτική λειτουργία του συστήματος υγείας. Από την άλλη πλευρά, τα συνταγογραφικά πρότυπα καθορίζουν τη φαρμακευτική κατανάλωση, και κατά συνέπεια το ύψος της φαρμακευτικής δαπάνης. Στην Ελλάδα εκτός από αποσπασματικές προσπάθειες σε συγκεκριμένα Κέντρα Υγείας δεν υπάρχουν επαρκείς πληροφορίες για τα συνταγογραφικά πρότυπα των ιατρών στην πρωτοβάθμια φροντίδα υγείας (ΠΦΥ) αλλά ούτε και για τις πεποιθήσεις τους σχετικά με την συνταγογράφηση. Σκοπός: Ο σκοπός της παρούσας διδακτορικής διατριβής ήταν να καταγράψει τα πρότυπα συνταγογράφησης των Γενικών Ιατρών (ΓΙ), να αναδείξει τις ιδιαιτερότητες στην συνταγογράφηση στην ΠΦΥ στην Ελλάδα συγκριτικά με άλλες Ευρωπαϊκές χώρες, και να διερευνήσει τις πεποιθήσεις των ΓΙ απέναντι στη συνταγογράφηση και την επιλογή του φαρμάκου. Μεθοδολογία: Η παρούσα έρευνα χρησιμοποίησε έναν συνδυασμό ποιοτικών και ποσοτικών μεθόδων και εργαλείων τα οποία συνέβαλαν στη σφαιρική προσέγγιση του θέματος λειτουργώντας συμπληρωματικά με σκοπό την κατανόηση της συμπεριφοράς των ΓΙ κατά την συνταγογράφηση. Ειδικότερα, αρχικά πραγματοποιήθηκε ποιοτική έρευνα με την χρήση της τεχνικής των ομάδων εστιασμένης συζήτησης (focus groups, FGs) και τη συμμετοχή 19 ΓΙ από 3 περιοχές της χώρας. Οι συζητήσεις καταγράφηκαν έπειτα από τη σύμφωνη γνώμη των συμμετεχόντων. Η ανάλυση περιεχομένου πραγματοποιήθηκε χρησιμοποιώντας τη Θεωρία Προσχεδιασμένης Συμπεριφοράς (ΤΡΒ) ως το θεωρητικό πλαίσιο για την διερεύνηση και την ταξινόμηση των κυρίαρχων πεποιθήσεων των ΓΙ ως προς την συνταγογράφηση. Στη συνέχεια και λαμβάνοντας υπόψη τα ποιοτικά αποτελέσματα, αναπτύχθηκαν δύο (2) ερωτηματολόγια. Το πρώτο ερωτηματολόγιο είχε σκοπό να καταγράψει τα πρότυπα συνταγογράφησης των Ελλήνων ΓΙ και χρησιμοποιήθηκε σε μια προοπτική διαστρωματική μελέτη με τη συμμετοχή 13 ΓΙ από την Κρήτη και την Αθήνα. Οι ΓΙ συμπλήρωσαν το ερωτηματολόγιο για 1202 ασθενείς και υπολογίστηκαν οι δείκτες για τα πρότυπα συνταγογράφησης. Το δεύτερο ερωτηματολόγιο αναπτύχθηκε βάσει της ΤΡΒ με σκοπό να διερευνηθεί η πρόθεση των ΓΙ να συνταγογραφήσουν φάρμακα σε ασθενείς κατά την διάρκειας μιας επίσκεψης σε μια δομή ΠΦΥ και να αξιολογηθούν οι προσδιοριστικοί παράγοντες της πρόθεσης συνταγογράφησης όπως ορίζονται στην ΤΡΒ. Το ερωτηματολόγιο συμπλήρωσαν 699 ΓΙ από 7 χώρες (Κύπρος, Τσεχία, Γαλλία, Ελλάδα, Μάλτα, Σουηδία και Τουρκία). Αποτελέσματα: Οι ΓΙ που συμμετείχαν στα FGs χαρακτήρισαν το φάρμακο ως ένα σημαντικό εργαλείο στην άσκηση της ιατρικής και τη συνταγογράφηση ως την κυριότερη ιατρική πράξη στην ΠΦΥ. Το εύρημα αυτό επιβεβαιώθηκε και στα επόμενα στάδια της έρευνας καθώς δόθηκε συνταγή στην πλειοψηφία των ασθενών που επισκέφθηκαν τους συμμετέχοντες ΓΙ. Η ποιοτική έρευνα ανέδειξε ιδιαιτερότητες κατά τη συνταγογράφηση φαρμάκων στην ΠΦΥ οι οποίες δυσκολεύουν την απόφαση συνταγογράφησης από τους ΓΙ και αφορούν την επαναλαμβανόμενη συνταγογράφηση για χρόνιο νόσημα χωρίς επανεξέταση, τη συνταγογράφηση δια αντιπροσώπου και τη συνταγογράφηση για σκευάσματα τα οποία ο ασθενής έχει ήδη προμηθευτεί από το φαρμακείο. Οι καταστάσεις αυτές έρχονται σε αντίθεση με την έννοια της ορθής συνταγογράφησης και η συχνότητα τους ξεπερνάει το 50% της συνολικής συνταγογράφησης, όπως επιβεβαιώθηκε στα επόμενα στάδια της έρευνας. Τα φαινόμενα αυτά εντοπίστηκαν σε όλες τις συμμετέχουσες χώρες σε μικρότερο ή μεγαλύτερο βαθμό με εξαίρεση τους ΓΙ από τη Σουηδία και την Τσεχία όπου καταγράφηκαν τα χαμηλότερα ποσοστά εμφάνισης αυτών των ιδιαιτεροτήτων. Οι ΓΙ σε όλες τις χώρες είχαν θετική στάση απέναντι στη συνταγογράφηση και ένιωθαν ότι είχαν τον έλεγχο της απόφασης συνταγογράφησης. Οι ΓΙ από την Κύπρο και την Ελλάδα ένιωθαν την μεγαλύτερη κοινωνική πίεση να συνταγογραφήσουν. Ειδικά, στην Ελλάδα οι ΓΙ θεωρούν ότι η συνταγογράφηση οδηγεί σε πλεονεκτήματα τόσο για την υγεία του ασθενή όσο και για το σύστημα υγείας. Τα μειονεκτήματα έχουν να κάνουν κυρίως με την εμφάνιση ανεπιθύμητων ενεργειών και την αύξηση της δαπάνης για τον ασθενή εξαιτίας των συν-πληρωμών. Οι ασθενείς και οι συγγενείς τους αποτελούν σύμφωνα με τους ΓΙ τις ομάδες που ασκούν πίεση για να συνταγογραφήσουν. Άλλες ομάδες οι οποίες ασκούν πίεση για συνταγογράφηση αλλά σε μικρότερο βαθμό είναι οι ιατρικοί επισκέπτες για τις πρακτικές των οποίων έχουν αντικρουόμενες απόψεις. Οι παράγοντες οι οποίοι διευκολύνουν την απόφαση συνταγογράφησης είναι η πεποίθηση ότι έχει γίνει σωστή διάγνωση, η ύπαρξη κατευθυντήριων οδηγιών και ο επαρκής χρόνος για την παροχή πληροφοριών σχετικά με τη χρήση των φαρμάκων. Στον αντίποδα, οι ιδιαιτερότητες της συνταγογράφησης όπως περιγράφηκαν νωρίτερα, και ο περιορισμένος διαθέσιμος χρόνος επίσκεψης δυσκόλευαν την απόφαση της συνταγογράφησης. Επίσης, η διερεύνηση των πεποιθήσεων των ΓΙ ως προς την συνταγογράφηση ανέδειξε την ανάγκη των ΓΙ για συνεχιζόμενη εκπαίδευση καθώς και την θετική τους γνώμη αναφορικά με τις κατευθυντήριες οδηγίες, τον έλεγχο της συνταγογράφησης και την πρόθεσή τους να συμμορφωθούν με τις συστάσεις και τις οδηγίες των υγειονομικών αρχών. Η πρόθεση συνταγογράφησης διέφερε μεταξύ των χωρών με τη χαμηλότερη να καταγράφεται στην Σουηδία και τη Μάλτα. Γενικά σε όλες τις χώρες οι συσχετίσεις της πρόθεσης συνταγογράφησης με τους προσδιοριστικούς παράγοντες όπως αυτοί ορίστηκαν από την ΤΡΒ ήταν χαμηλές, ενώ το υπόδειγμα της ΤΡΒ μπόρεσε να ερμηνεύσει σε μικρό βαθμό την πρόθεση συνταγογράφησης μόνο στη Μάλτα και στην Τσεχία. Συμπεράσματα: Η παρούσα μελέτη διερεύνησε για πρώτη φορά στην Ελλάδα τις πεποιθήσεις των ΓΙ ως προς την συνταγογράφηση χρησιμοποιώντας το υπόδειγμα της ΤΡΒ, το οποίο στη συνέχεια εφαρμόστηκε σε 7 Ευρωπαϊκές χώρες. Επίσης, κατέγραψε και μέτρησε τις ιδιαιτερότητες της συνταγογράφησης σε όλες τις χώρες που συμμετείχαν και ανέδειξε για πρώτη φορά στην Ελλάδα το φαινόμενο της συνταγογράφησης σκευασμάτων τα οποία ο ασθενής έχει ήδη προμηθευτεί από το φαρμακείο. Τα ευρήματα της παρούσας έρευνας δείχνουν ότι η συνταγογράφηση του φαρμάκου δεν είναι πάντα μια ορθολογική απόφαση, αλλά στην τελική επιλογή συμβάλλει μια πληθώρα παραγόντων διαφορετικών σε κάθε χώρα. Η παρούσα μελέτη απέδειξε ότι υπάρχουν περιθώρια βελτίωσης της συνταγογράφησης και ανέδειξε τα σημεία στα οποία θα πρέπει να εστιάσουν οι πολιτικές για την βελτίωσή της. Τα ευρήματα της παρούσας μελέτης αναμένεται να συμβάλλουν στην καλύτερη κατανόηση των εκπαιδευτικών αναγκών αφενός των ΓΙ και αφετέρου των φαρμακοποιών και των ασθενών καθώς έμμεσα επηρεάζουν την απόφαση της συνταγογράφησης. Παράλληλα αναμένεται να έχει αντίκτυπο στο σχεδιασμό κατάλληλων πολιτικών για τη βελτίωση της συνταγογράφησης και στην καθοδήγηση της μελλοντικής έρευνας

Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece

Background: Financial crisis and worsened socio-economic conditions are associated with greater morbidity, less utilization of health services and deteriorated population’s health status. The aim of the present study was to investigate the determinants of self-rated health in Greece. Methods: Two national cross-sectional surveys conducted in 2006 and 2011 were combined, and their data were pooled giving information for 10 572 individuals. The sample in both studies was random and stratified by gender, age, degree of urbanization and geographic region. Logistic regression analysis was used to determine the impact of several factors on self-rated health. Results: Poor self-rated health was most common in older people, unemployed, pensioners, housewives and those suffering from chronic disease. Men, individuals with higher education and those with higher income have higher probability to report better self-rated health. Furthermore, the probability of reporting poor self-rated health is higher at times of economic crisis. Conclusion: Our findings confirm the association of self-rated health with economic crisis and certain demographic and socio-economic factors. Given that the economic recession in Greece deepens, immediate and effective actions targeting health inequalities and improvements in health status are deemed necessary

Cost-effectiveness of Ingenol Mebutate Gel for the Treatment of Actinic Keratosis in Greece

Purpose: The present study aimed to perform a cost-effectiveness analysis of ingenol mebutate (IM) versus other topical alternatives for the treatment of actinic keratosis (AK). Methods: The analysis used a decision tree to calculate the clinical effects and costs of AK first-line treatments, IM (2-3 days), diclofenac 3% (for 8 or 12 weeks), imiquimod 5% (for 4 or 8 weeks), during a 24 month horizon, using discrete intervals of 6 months. A hypothetical cohort of immunocompetent adult patients with clinically confirmed AK on the face and scalp or trunk and extremities was considered. Clinical data on the relative efficacy were obtained from a network meta-analysis. Inputs concerning resource use derived from an expert panel. All costs were calculated from a Greek third-party payer perspective. Findings: IM 0.015% and 0.05% were both cost-effective compared with diclofenac and below a willingness-to-pay threshold of (sic)30,000 per quality adjusted life-year (QALY) (sic)199 and (sic)167 per QALY, respectively). Comparing IM on the face and scalp AK lesions for 3 days versus imiquimod for 4 weeks resulted in an incremental cost-effectiveness ratio of (sic)10,868 per QALY. IM was dominant during the 8-week imiquimod period. IM use on the trunk and extremities compared with diclofenac (8 or 12 weeks) led to incremental cost-effectiveness ratios estimated at (sic)1584 and (sic)1316 per QALY accordingly. Results remained robust to deterministic and probabilistic sensitivity analyses. (C) 2017 Elsevier HS Journals, Inc. All rights reserved

Cost-Effectiveness Analysis of Ranibizumab versus Verteporfin Photodynamic Therapy, Pegaptanib Sodium, and Best Supportive Care for the Treatment of Age-Related Macular Degeneration in Greece

Background: Age-related macular degeneration (AMD) is a progressive disease that results in loss of central vision, significant functional impairment, and a subsequent heavy socioeconomic burden. AMD treatments delay disease progression, improve patient outcomes, and reduce resource use associated with visual impairment, however, in a varying way concerning costs and effects. Objective: The purpose of this study was to investigate the cost effectiveness of ranibizumab compared with verteporfin photodynamic therapy, pegaptanib sodium, and best supportive care for the treatment of AMD in Greece. Methods: A 6-state Markov model was constructed according to patient visual acuity in the better-seeing eye. Data on effectiveness were derived from randomized controlled trials evaluating the outcomes of ranibizumab versus alternative AMD treatments. Resource utilization reflected the Greek health care setting and was defined by a panel of experts. All treatments were administered for a 2-year period and evaluated during a 10-year time frame from a third-party payer perspective and discounted at 3.5% per annum. Results: Estimated mean 10-year direct costs of treatment in the ranibizumab arm ranged from (sic)23,733 to (sic)31,795 (2011 Euros), with a projected gain of 4.50 to 4.74 quality-adjusted life years (QALYs) or 2.97 to 4.47 vision years, depending on type of lesion. For predominantly classic lesions, the cost per QALY gained with ranibizumab was estimated at (sic)6444/QALY (95% uncertainty interval [UI], (sic)-30,403/QALY to (sic)44,524/QALY), (sic)15,344 (95% UI, (sic)-11,433 to (sic)53,554) and dominant relative to photodynamic therapy, best supportive care, and pegaptanib, respectively. Corresponding ratios for patients with minimally classic lesions were (sic)24,580/QALY (95% UI, (sic)-5580/QALY to (sic)76,229/QALY) and (sic)13,112/QALY (95% UI, (sic)-3839/QALY to (sic) 37,527/QALY) for ranibizumab relative to best supportive care and pegaptanib, and for patients with occult lesions were estimated at (sic)19,407/QALY (95% UI, (sic)-1486 to (sic)46,434) and (sic)28,561/QALY (95% UI, (sic)6143 to 73,431), respectively. Sensitivity analysis provided robust results in all cases. Conclusion: Ranibizumab can be a cost-effective option for the treatment of AMD compared with selected alternatives in the Greek health care setting. (Clin Ther. 2012;34:446-456) (C) 2012 Elsevier HS Journals, Inc. All rights reserved

Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey

Background: Over the past few decades, drug and overall healthcare expenditure have risen rapidly in most countries. The present study investigates the attitudes and the factors which influence physician prescribing decisions and practice in Greece and Cyprus. Methods: A postal questionnaire was developed by researchers at the Department of Health Economics at the National School of Public Health in Greece, specifically for the purposes of the study. This was then administered to a sample of 1,463 physicians in Greece and 240 physicians in Cyprus, stratified by sex, specialty and geographic region. Results: The response rate was 82.3% in Greece and 80.4% in Cyprus. There were similarities but also many differences between the countries. Clinical effectiveness is the most important factor considered in drug prescription choice in both countries. Greek physicians were significantly more likely to take additional criteria under consideration, such as the drug form and recommended daily dose and the individual patient preferences. The list of main sources of information for physicians includes: peer-reviewed medical journals, medical textbooks, proceedings of conferences and pharmaceutical sales representatives. Only half of prescribers considered the cost carried by their patients. The majority of doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may not be excellent but it is acceptable. However, only Cypriot physicians actually prescribe them. Physicians believe that new drugs are not always better and their higher prices are not necessarily justified. Finally, doctors get information regarding adverse drug reactions primarily from the National Organisation for Medicines. However, it is notable that the majority of them do not inform the authorities on such reactions. Conclusion: The present study highlights the attitudes and the factors influencing physician behaviour in the two countries and may be used for developing policies to improve their choices and hence to increase clinical and economic effectiveness and efficiency

General Practitioners&apos; intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project

The aim of this paper is to explore general practitioners’ (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs’ prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary. (C) 2015 Elsevier Ireland Ltd. All rights reserved

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

International audienceBackground: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the " OTC SOCIOMED " , conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region.Methods: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre-and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs' intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs.Results: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale