Public perception of pharmacist-prescribed self-administered non-emergency hormonal contraception: An analysis of online social discourse

BackgroundIncreasing access to hormonal contraception reduces unintended pregnancies. One strategy gaining momentum is allowing patients to access hormonal contraception directly from pharmacists. Commentary on online news articles provides a naturalistic and real-time data source to assess public perceptions on timely and often controversial issues.ObjectiveCharacterize public perceptions of pharmacist-prescribed self-administered non-emergency hormonal contraception using comments posted in response to online news articles.MethodsRetrospective, cross-sectional, mixed methods analysis of public comments posted in response to articles published by major media outlets between January 1 to December 31, 2015 on pharmacist-prescribed hormonal contraception. Comments were then extracted and reviewed through a two-step process to identify emerging themes using a thematic analysis.ResultsA total of 1060 public online comments were collected from eight articles. Of these, 757 comments (71.4%) were not related to pharmacist-prescribed hormonal contraception. Thematic analysis of the 303 relevant comments (28.6%) identified three overarching messages. First, a wide variety of reasons for how pharmacist-prescribed hormonal contraception improves healthcare and/or supports patient preferences were cited, but there was no consensus on the primary vantage. Second, individuals have varying opinions about the role of the pharmacist which creates both opportunities and challenges for pharmacist-prescribed hormonal contraception. Third, practical and logistical considerations will need to be addressed by healthcare systems, pharmacies, and payers prior to and alongside implementation.ConclusionCommenters were generally positive and cited several benefits, such as increasing access to healthcare, reducing unintended pregnancies, and supporting individual autonomy. However, it was acknowledged that these benefits would need to be balanced with potential safety concerns and logistical issues associated with delivering clinical services in a community pharmacy setting. Study results can help understand public concerns and may be useful in addressing barriers hindering public acceptance of expanded pharmacist roles.     

How can Saudi Arabia reform its public hospital payment models? A narrative review

BackgroundThe cost of Saudi healthcare continues to rise at an alarming rate, putting the sustainability of the public healthcare system into question. Data have shown that hospital and healthcare providers’ services represent the bulk of this rising cost, which makes the calls to reform the Saudi healthcare system more focused on payment models than at any time before.ObjectiveThe aim of this paper is to review various identified payment models that can be used to contain costs and improve the quality of the care provided.MethodA literature review of articles addressing the issues of cost containment and improving the quality of healthcare by reforming the current Saudi healthcare payment policy were identified through the Ovid®, Medline, and Google® Scholar search engines.Results and ConclusionsMany research articles and literature reviews have identified and discussed different models of healthcare payments. Some articles have focused on one payment model, while others have discussed different payment models that have been identified. There is an urgent need to reform the current system of healthcare payments to improve the quality of healthcare and maintain funding for universal healthcare coverage in the future. Future healthcare payment reforms should consider restructuring the current healthcare system, which is largely fragmented by providing incentives to different governmental healthcare sectors, in order to transform it into a more organized and coordinated system. Thus far, there is not a single payment model that can, by itself, reduce healthcare costs and improve healthcare quality. Future healthcare reforms should use a mixture of different payment models to pay hospitals and physicians.     

MEDICAL COSTS AND UTILIZATION TRENDS IN CHINA: IMPLEMENTING MARKET AND REGULATORY REFORMS

Abstract

The Chinese medical system is moving from a planned economy to a market economy through implementing health reforms. The authors examine empirical data on China's health system from the past 10 years about the organization, financing, and equity. The data show high medical inflation rates, low percent of GDP spent on healthcare, limited relative supply of the more sophisticated tertiary centers, and increased out-of-pocket outlays. Based on linear coefficient analysis of health expenditure and utilization trends, the authors contend that the reforms need to incorporate regulatory measures that assure insurance coverage through the reorganization of health services delivery and financing.     

Driving among drug users: Are we doing enough? A chart review of assessment of driving and related issues in drug misusers

Aim: Driving among drug users is a major health concern. Professionals working in substance misuse service have a duty of care to manage the risks involved. We analysed the practice of multidisciplinary team in drug treatment service discussing driving with the patient and providing them with relevant information regarding the regulations. We compared this practice with the existing policies and guidelines.

Method: A chart review of healthcare professionals in the drug treatment services discussing driving and related issues with the patient was carried out. One hundred case records were analysed for evidence of documentation of the above information.

Results: A clear record of discussion of all driving-related issues was documented in only 28% of records reviewed. In more that half of the cases there was no record as to whether the patient was driving or not.

Conclusions: The results raised some ethical questions that would influence the policy makers and practitioners. These finding suggest that major changes are needed in our practice both for our legal protection and for the best interests of patients and public.     

Pharmacist provider status: Geoprocessing analysis of pharmacy locations,medically underserved areas,populations, and health professional shortage areas

BackgroundPayment reform for pharmacists is both an important and urgent issue that needs to be addressed.Objective(s)The purpose of this paper is to assess the use of medically underserved areas, medically underserved populations, and primary care health professional shortage areas in The Pharmacy and Medically Underserved Areas Enhancement Act; and provide policy recommendations for national pharmacy associations to achieve provider status.MethodsPharmacy location addresses were determined using public domain data from the National Plan & Provider Enumeration System (NPPES) National Provider Identifier (NPI) Registry. Medically Underserved Areas/Populations (MUAs/MUPs) and Health Professional Shortage Areas (HPSAs) were gathered through public data provided by the Health Resources and Services Administration as Keyhole Markup Language (KML) files. Addresses and KML files were analyzed and mapped using the geographic information software, QGIS. A series of maps depicting the location of all MUAs/MUPs, HPSAs, HPSA facility locations, and community pharmacy locations in the U.S. were then created. These maps were overlayed, and geoprocessing tools were used to create the analysis.ResultsAfter analyzing all community pharmacy locations in the United States, we found that only 56% are located within a current MUA/MUP or HPSA. The percentage of pharmacies in healthcare underserved areas differs widely between states from the lowest in New Jersey of 18.26% of pharmacies to the highest of Guam, the Northern Mariana Islands and the Virgin Islands with 100% of pharmacies.ConclusionsAligning the pharmacist business model to be comparable to other health care professionals will ensure patients receive access to pharmacist-provided cognitive patient care services, which have higher value than product-centered services. Future attempts to recognize pharmacists as providers and allow for their reimbursement under Medicare Part B should consider strategies to increase the number of pharmacists that are eligible to participate in order to exemplify value to the public and elected leaders.     

“Designer Genes and the Politics of Fear”

Abstract

The recent large commitment of capital and personnel to biotechnology by multi national corporations is evidence that management believes scientists can develop a wide range of products for human and animal health and the production of crops. Yet current food surpluses create an atmosphere wherein actions taken by those who fear the development of biotechnology have succeeded in halting planned experiments and popularized accounts of vast public danger. Thus, the regulatory process for biotechnology is one of the major challenges facing society.

There is need for leadership by industry to present fact, correct misimpressions, debate issues, and to be as dedicated to resolution of the regulatory aspects of biotechnology as to the development of the science itself.     

The Reaction of Stakeholders to the Role of the Brazilian Federal Agency for Health Plans

Abstract

The role of the newly created brazilian regulatory agency for the health plans market is a work in progress. In this paper, the author describes the brazilian healthcare system structure and evolution, in order to put in context the reasons that eventually determined the creation of such organ. The stakeholder theory is utilized as a framework to analyze the reactions to the creation of the agency. It is postulated that the agency has established itself as a player in the market, in spite of initial doubts about its legitimacy.     

Demonstrating institutional trustworthiness: A framework for pharmacy regulatory authorities

BackgroundSelf-regulation is well suited for health care providers as the distinctive knowledge requirements can be effectively managed by those with the specific knowledge base compared to national or provincial/state governments. Despite their prevalence and long history in health care, self-regulating professions have become a topic of increasing debate as a result of evidence of declines in trust in a number of institutional contexts.ObjectiveIt is important that Pharmacy Regulatory Authorities (PRAs), as the regulating body for a critical health profession, can demonstrate and proactively respond to issues related to public trust. Such capabilities are needed to address an overall decline in trust in self-regulated professions and allow PRAs to quickly address issues that may impact public trust within their own jurisdiction. However, a process and best practices that allow PRAs to demonstrate institutional trustworthiness to the public is lacking. Given the need from both a research and practice perspective, this research develops a conceptual framework of how PRAs can demonstrate institutional trustworthiness to the public.MethodsThe literature was reviewed to identify dominant themes associated with regulatory practice that would serve to demonstrate institutional trustworthiness of PRAs to the public. Eight best practice themes emerged: public interest objective, transparency, engagement, accountability, independence, collaboration, adaptability, and awareness.ResultsThe conceptual framework is comprised of six key steps, related to defining public interest orientation, implementing trust-related best practices, developing a communication strategy to increase public awareness of PRA activities, monitoring symbolic capital, assessing public trust in registrants (interpersonal trust), and assessing public and registrant trust in the regulator (institutional trust).ConclusionFuture research should develop pharmacy-focused instruments related to trust, establish baseline measures of registrant and public trust in pharmacy regulatory authorities, and explore issues of public trust in PRAs between different cultures and developed and developing countries.     

我国互联网销售处方药的监管研究

目的:为我国互联网药品销售的监管提供参考依据,更好地促进我国互联网药品交易健康发展.方法:梳理与分析我国互联网销售处方药的监管政策,平行对比国外的监管政策和措施,找到适合我国国情的监管策略.结果 与结论:随着"互联网+"的蓬勃发展,互联网药品销售也成为了医药行业成长前进的重要方向.建议不断完善和优化处方药网售的监管政策...     

The burden of illness associated with psoriasis: cost of treatment with systemic therapy and phototherapy in the US

SUMMARY

Objective: To evaluate utilization and direct healthcare expenditures among psoriasis patients treated with systemic therapy and phototherapy in the United States.

Design: Cohort study using retrospective administrative medical claims.

Patients: Psoriasis patients treated with systemic therapy and phototherapy, as well as a matched cohort of non-psoriasis patients. All patients were covered by employer-sponsored insurance between 1 April 1996 and 31 December 2000.

Main outcome measures: Estimated risk of hospitalization and total annual healthcare expenditures overall and by comorbidity status were compared for persons with psoriasis using systemic therapy or phototherapy and persons without psoriasis. Annualized utilization rates for hospitalizations, and use of emergency department, outpatient physician, outpatient laboratory, and outpatient pharmaceutical services were also compared across the two cohorts.

Results: Seventeen percent of psoriasis patients were treated with systemic therapy or phototherapy. Patients with comorbid anemia, carcinoma, diabetes, depression, GI disorders, hepatotoxicity, hypertension, and nephrotoxicity had significantly higher expenditures than non-psoriasis patients with the same comorbidities (?p ≤ 0.05). Elevated risk of hospitalization also contributed to higher expenditures in patients treated with systemic therapy or phototherapy. Limitations of this study include those inherent in using claims data such as dependence on diagnosis coding, the fact that psoriasis severity cannot be determined directly from claims data, confounding comorbidities, and the fact that only direct healthcare expenditures were considered in this analysis.

Conclusion: Psoriasis patients treated with systemic therapies/phototherapies have significantly more comorbidities and higher mean total healthcare expenditures compared to non-psoriasis patients. Psoriasis patients with selected comorbidities have significantly higher mean total healthcare expenditures compared to non-psoriasis persons with the same comorbidities.     

我国医疗器械网络交易监管研究

目的：为完善我国医疗器械网络交易的监督管理提供参考意见。方法：通过对医疗器械网络交易的概况和监管现状进行分析,梳理其取得的进步和存在的问题,并由此提出相关改进路径。结果与结论：近年来,我国医疗器械网络交易的监管取得了一些进步,但仍存在监管体系不完善、处罚规定不合理、需求群体判别能力差等问题,完善监管模式、促进行业发展需要从增强处罚力度、建立协同监管平台、加强消费者教育、建立行业自律等方面着手。     

Some Effects of Nitrous Oxide on Fear

Abstract

Legitimate human research with hallucinogenic drugs, although of great theoretical and practical interest, involves daunting regulatory hurdles that have discouraged investigators from attempting such work. Using the example of the author's own application for and receipt of federal permission to administer N,N-dimethyltryptamine (DMT) to humans, this article reviews the application process, obstacles and their solutions, and the local and federal issues involved. Further human research with hallucinogens is possible if a persistent and collaborative effort is made with the relevant institutions that oversee the performance of this type of research.     

Effective integration of pharmacovigilance systems at public health facilities in resource-limited settings: A qualitative study

BackgroundPharmacovigilance systems increase access to safe medicines and healthcare, but their integration in public healthcare remains a challenge in many countries. The main barriers to pharmacovigilance integration are attributed to high patient load and limited capacities.ObjectiveTo explore the challenges associated with the effective integration of pharmacovigilance systems in public healthcare in a developing country such as Namibia.MethodsA nationwide qualitative assessment of integration of pharmacovigilance systems particularly spontaneous adverse drug reaction (ADR) reporting at public health facility level was conducted. Key informant interviews were conducted among pivotal healthcare professionals involved in pharmacovigilance. The main outcomes were themes on challenges and strategies for effective integration of PV services at the facility level. Qualitative data were collected over a one-month period (i.e., March 2019), and thematically analysed.ResultsEight (8) key informants were recruited; the majority were pharmacists (n = 7) and male (n = 5). The main challenges affecting the effective integration of pharmacovigilance systems reporting at public health facilities were “weak pharmacovigilance policies and structures”, “negative attitude of healthcare workers towards pharmacovigilance”, and “limited capacity and support for implementation of pharmacovigilance activities”. The main strategies for effective integration of PV systems at facilities included local capacity-building through continuing profession education and support, advocacy, stakeholder engagement, facility/region based pharmacovigilance champions, and facility-based policies for universal and inclusive reporting, (i.e. patients and health workers at all levels) as well as development of workable standard operational procedures.ConclusionsThe pharmacovigilance systems at healthcare facilities in Namibia were observed to have sub-optimal policies, structures and support systems, and lack health care worker buy-in. There is a need for a policy framework to ensure effective and sustainable integration of pharmacovigilance activities at public healthcare facilities.     

Outcomes and healthcare resource utilization associated with medically attended hypoglycemia in older patients with type 2 diabetes initiating basal insulin in a US managed care setting

Objective: To assess health outcomes and the economic burden of hypoglycemia in older patients with type 2 diabetes initiating basal insulin (BI).

Research design and methods: Medicare Advantage claims data were extracted for patients with type 2 diabetes initiating BI and patients were stratified into two groups: those with medically attended hypoglycemia during the first year of BI treatment (HG group) and those without (non-HG group). Main outcome measures were hospitalization, mortality, healthcare utilization and costs 1 year before and 1 year after BI initiation.

Results: Of 31,035 patients included (mean age 72 years [SD 9.2]), 3066 (9.9%; HG group) experienced hypoglycemia during 1 year post-BI initiation. After adjustment for demographic, comorbidity and medication history, hypoglycemia was associated with risk of hospitalization (HR 1.59; 95% CI: 1.53–1.65) and death (HR 1.50; 95% CI: 1.40–1.60). Healthcare utilization was higher pre-index and showed greater increases post-BI initiation in the HG vs. the non-HG group. Per-patient healthcare costs were substantially higher for the HG group than the non-HG group, both pre-index ($54,057 vs. $30,249, respectively) and post-BI initiation ($75,398 vs. $27,753, respectively).

Conclusions: Based on available claims data, hypoglycemia during the first year of BI treatment is associated with risk of hospitalization or death in older people, increasing healthcare utilization and costs. Due to the observational nature of this study, causality cannot be attributed, and further prospective studies into the effect of hypoglycemia on health outcomes in this population are warranted.     

Consensus development methods: Considerations for national and global frameworks and policy development

Backgroundkey decisions have to be made in healthcare systems and policies often under uncertain conditions or without complete objective evidence. Decisions made on the health system and policy levels affect national and global population, which requires transparency and accountability to ensure the best impact to population's health. Consensus development methods assist complex process of the decision making combining existing evidence and expert opinions. Variety of challenges affect the selection, application and use of the consensus development methods, which requires careful consideration to keep rigour, validity and transparency.ObjectiveTo identify and review studies which have used consensus development methods in order to develop national or international policy or framework in health field.MethodsA literature review was conducted searching the databases PubMed, EMBASE and PsycINFO. Studies using a consensus development approach to develop tools or frameworks for health system and policy enhancement were eligible for the review. Key elements of consensus development process were extracted and reported using content analysis and narrative synthesis.ResultsThe review included 26 studies in total either in national or international settings. Over 60% of studies extracted did not apply typical consensus development methods; however, stated as consensus meetings instead. Delphi technique was the most used method from the consensus development methods, which often combined with some face-to-face meeting features.ConclusionsThis review summarised the use of consensus development methods in health system and policy development. The review identified a wide range of variations in the selection, use and application of the methods in studies. For better utilisation and application of the consensus development methods in the field, some standardisation of the methods and reporting would be warranted.     

A blended model to support brief interventions in primary care: A qualitative study of usability and acceptability of HealthEir in community pharmacy

BackgroundBrief interventions for lifestyle behaviour change are effective health promotion interventions. Primary care settings, including pharmacies, are the most frequently visited healthcare facilities and are well placed to provide brief health interventions. However, despite the evidence-based and policy guidance, barriers to brief interventions have limited their implementation.ObjectivesThis study aimed to explore the usability and acceptability of HealthEir, a blended model with digital, print, and communication elements designed to support the delivery of brief health-promoting interventions in pharmacy practice.MethodsUsability tests using a think aloud protocol and set tasks (to assess usability) and semi-structured interviews (to assess acceptability) were conducted with fifteen patients and twelve pharmacists. Usability data were analysed deductively using Nielsen's five quality components of usability as a framework. Acceptability data were analysed using inductive thematic analysis.FindingsAll participants found HealthEir straightforward to use and completed the required tasks without assistance. A small number of patient and pharmacist participants identified opportunity for improvement of the digital element. Acceptability was also high, with individual comments from participants identifying opportunity for improvements to HealthEir, and two patients identifying privacy or safety concerns. The majority of comments regarding acceptability reflected wider social and cultural challenges such as perceptions of the roles of pharmacists and pharmacies and the low priority of preventative health interventions.ConclusionHealthEir has been demonstrated to be a usable and acceptable support that has the potential to overcome barriers to delivery of brief interventions in pharmacies. Usability and acceptability testing identified minor changes that may further improve its design prior to piloting and implementation.