Perceptions of the influence of prescription medicine samples on prescribing by family physicians

Background: The provision of free prescription medicine samples is a common and traditional marketing strategy used by pharmaceutical companies, but concerns have been raised about their influence on physician prescribing behavior and patient safety. Objective: We sought to investigate the knowledge, attitudes, and behaviors of Australian family physicians regarding the use of sample prescription medications. Methods: Qualitative and quantitative techniques were used, including (1) mailed questionnaires to family physicians, (2) semistructured interviews with family physicians, and (3) sample cupboard inventories. Results: A number of issues about samples were identified by the questionnaires (208) and interviews (17 doctors), including insufficient labeling, poor record keeping, diversion of stock (personal use by doctors.. their families, practice staff and pharmaceutical representatives), and wasting of expired stock. Prescription medicine samples also influenced prescribing behavior. Australian doctors were less likely to provide samples to patients on financial grounds compared with a previous study in the United States on medical residents. Six sample cupboards were inventoried. Median wholesale value of sample cupboards was AUD $4959 (range $2395-$8709), with 6% of stock expired. Very little generic medicine was included in the sample cupboards. Conclusions: Better methods are needed to meet legislative requirements and to ensure quality use of medicines (and optimal public health) with respect to prescription medicine samples. Doctors and practice staff require training on the appropriate handling and storage of prescription medications. Alternative ways for distribution of sample medications need to be investigated.

Technologies de prescription informatisée et transformation du rôle des pharmaciens communautaires

L’amélioration de la qualité de l’utilisation des médicaments dans les soins primaires est devenue un enjeu crucial. Les pharmaciens communautaires se présentent comme des acteurs centraux dans l’atteinte de cet objectif, en réclamant une extension de leur rôle. L’objectif principal de cette thèse est de mieux comprendre comment les technologies de prescription informatisée (eRx) influencent la transformation du rôle des pharmaciens communautaires. Le premier article présente les résultats d’une étude de cas qui aborde la transformation du rôle des pharmaciens communautaires à partir du concept de professionnalisation. Elle propose un modèle logique des influences d’une technologie de eRx sur cette professionnalisation, élaboré à partir de la typologie de Davenport. Ce modèle logique a été validé en interviewant douze pharmaciens communautaires participant à un projet pilote typique de technologie de eRx. A partir des perceptions des pharmaciens communautaires, nous avons établi que la technologie était susceptible de soutenir la professionnalisation des pharmaciens en passant par cinq mécanismes : la capacité analytique, l’élimination des intermédiaires, l’intégration, l’automatisation et la diffusion des connaissances. Le deuxième article analyse les perturbations induites par les différentes fonctions des technologies de eRx sur la stabilité de la juridiction des pharmaciens communautaires, en se basant sur un cadre de référence adapté d’Abbott. À partir de trente-trois entrevues, avec des praticiens (médecins et pharmaciens) et des élites, cette étude de cas a permis de décrire en détail les influences des différentes fonctions sur les modalités d’action des professionnels, ainsi que les enjeux soulevés par ces possibilités. La perturbation principale est liée aux changements dans la distribution des informations, ce qui influence les activités de diagnostic et d’inférence des professionnels. La technologie peut redistribuer les informations relatives à la gestion des médicaments autant au bénéfice des médecins qu’au bénéfice des pharmaciens, ce qui suscite des tensions entre les médecins et les pharmaciens, mais aussi parmi les pharmaciens. Le troisième article présente une revue systématique visant à faire une synthèse des études ayant évalué les effets des technologies de eRx de deuxième génération sur la gestion des médicaments dans les soins primaires. Cette revue regroupe dix-neuf études menées avec des méthodes observationnelles. Les résultats rapportés révèlent que les technologies sont très hétérogènes, le plus souvent immatures, et que les effets ont été peu étudiés au-delà des perceptions des utilisateurs, qui sont mitigées. Le seul effet positif démontré est une amélioration de la qualité du profil pharmacologique accessible aux professionnels, alors que des effets négatifs ont été démontrés au niveau de l’exécution des prescriptions, tels que l’augmentation du nombre d’appels de clarification du pharmacien au prescripteur. Il semble donc que l’on en connaisse peu sur les effets des technologies de eRx de deuxième génération. Ces trois études permettent de constater que les nouvelles technologies de eRx peuvent effectivement influencer la transformation du rôle du pharmacien communautaire en perturbant les caractéristiques des prescriptions, et surtout, l’information et sa distribution. Ces perturbations génèrent des possibilités pour une extension du rôle des pharmaciens communautaires, tout en soulignant les défis intra et interprofessionnels associés à l’actualisation de ces possibilités. Dans l’ensemble, nos résultats soulignent que les perturbations associées aux technologies de eRx dépassent les éléments techniques du travail des utilisateurs, pour englober de multiples perturbations quant à la nature même du travail et du rôle des professionnels. Les décideurs et acteurs impliqués dans le déploiement des technologies de eRx auraient avantage à prendre en compte l’ensemble de ces considérations pour rapprocher les effets observés des bénéfices promis de ces technologies.

Acesso, segurança e uso de medicamentos por usuários

The present study aims to identify families who have stock and are making use of medications, as well as assess the conditions of storage, security and use of these drugs. The study was conducted in a city of São Paulo, the interviews were conducted in households enrolled in one of ten units of the Estratégia de Saúde da Família (ESF) that the city provides and the sample was defined by means of stratified random sampling (134households, IC 95%). Data collection was conducted through interviews with a semistructured questionnaire during the first half of 2011. We interviewed 118 (88.0%) households, of which 112 (95.0%) had medications that were stored n insecure or inadequate places in 75.4% of households, non-prescription self-medication was a common practice in 46 (47 4%) households, and lack of identification and security of medications stored was observed in 60 (53.6%) households. Most households had stock of medicines, which were done improperly or unsecure, or have specialties with lack of identification and security, which can lead to poisoning or e ineffective therapy. The Pharmaceutical Assistance under SUS lacks social initiatives, with actions directed for medications users, which can be supplied by the presence of the pharmacist in the ESF, essential for the promotion of racional use of medicines, that, through the Pharmaceutical Care, can identify, correct and prevent possible problems related to drugs.

I shouldn't have to do this: Illegitimate tasks as a stressor in relation to organizational control and resource deficits

The performance of tasks that are perceived as unnecessary or unreasonable, illegitimate tasks, represents a new stressor concept that refers to assignments that violate the norms associated with the role requirements of professional work. Research has shown that illegitimate tasks are associated with stress and counterproductive work behaviour. The purpose of this study was to provide insight into the contribution of characteristics of the organization on the prevalence of illegitimate tasks in the work of frontline and middle managers. Using the Bern Illegitimate Task Scale (BITS) in a sample of 440 local government operations managers in 28 different organizations in Sweden, this study supports the theoretical assumptions that illegitimate tasks are positively related to stress and negatively related to satisfaction with work performance. Results further show that 10% of the variance in illegitimate tasks can be attributed to the organization where the managers work. Multilevel referential analysis showed that the more the organization was characterized by competition for resources between units, unfair and arbitrary resource allocation and obscure decisional structure, the more illegitimate tasks managers reported. These results should be valuable for strategic-level management since they indicate that illegitimate tasks can be counteracted by means of the organization of work.

Government of public education for adequate policy making.

Includes bibliographical references.

How much do patients in Blantyre, Malawi know about antibiotics and other prescription only medicines?

Introduction This qualitative and quantitative exploratory study was conducted to assess patients’/customers’ knowledge, beliefs and practices about antibiotics and other prescription only medication (POM) in 10 community pharmacies in Blantyre, Malawi. Method 5 out of 10 pharmacies were selected by simple random sampling and 54 participants attending the selected pharmacies were interviewed. Results The major antibiotic drugs frequently requested without a doctor’s prescription were Bactrim (Cotrimoxazole) and amoxicillin. Knowledge of these medicines was attributed to the patients’ previous medical conditions and doctor’s prescription. However this knowledge does not extend to understanding of proper therapeutic indications and dosage regimens for antibiotic therapy. The majority (30 out of 54 participants) did not know about the importance of completing a prescribed course of antibiotics. All 54 participants believed in the efficiancy of antibiotics. Conclusion Study participants had wide range of knowledge about antibiotics and other POM from hospital, but the majority had limited knowledge regarding clinical indications and correct dosage schedules.

An interprofessional approach to improving paediatric medication safety

Safe drug prescribing and administration are essential elements within undergraduate healthcare curricula, but medication errors, especially in paediatric practice, continue to compromise patient safety. In this area of clinical care, collective responsibility, team working and communication between health professionals have been identified as key elements in safe clinical practice. To date, there is limited research evidence as to how best to deliver teaching and learning of these competencies to practitioners of the future.An interprofessional workshop to facilitate learning of knowledge, core competencies, communication and team working skills in paediatric drug prescribing and administration at undergraduate level was developed and evaluated. The practical, ward-based workshop was delivered to 4th year medical and 3rd year nursing students and evaluated using a pre and post workshop questionnaire with open-ended response questions.Following the workshop, students reported an increase in their knowledge and awareness of paediatric medication safety and the causes of medication errors (p < 0.001), with the greatest increase noted among medical students. Highly significant changes in students' attitudes to shared learning were observed, indicating that safe medication practice is learnt more effectively with students from other healthcare disciplines. Qualitative data revealed that students' participation in the workshop improved communication and teamworking skills, and led to greater awareness of the role of other healthcare professionals.This study has helped bridge the knowledge-skills gap, demonstrating how an interprofessional approach to drug prescribing and administration has the potential to improve quality and safety within healthcare.

Perfil de utilização de medicamentos em usuários da rede básica de saúde de Lorena, SP

Estudo transversal desenvolvido com a clientela da clínica médica das Unidades Básicas de Saúde de Lorena (SP) com o objetivo de descrever o perfil de utilização de medicamentos em adultos e idosos. Foram coletados dados sobre características sociodemográficas, razões de procura do serviço, prescrição medicamentosa, identificação do(s) medicamento(s) utilizado(s) no último mês, local de aquisição do(s) mesmo(s), automedicação e uso de medicamento(s) homeopático(s). Foram entrevistados 766 indivíduos, sendo 66% do sexo feminino. Mais de 46% dos entrevistados referiram existência de doença crônica e a maioria se considerava em bom estado de saúde. A prescrição de medicamentos alcançou cerca de 70% da população, com média de 1,5 medicamento por pessoa, a maioria anti-hipertensivos. Este número aumentou com o aumento da idade, foi maior nas situações de manutenção do estado de saúde e casos de doença, na existência de doença crônica, nos casos auto-referidos como estado de saúde ruim para os homens e regular para as mulheres. Para as mulheres, também foi maior para as não inscritas em alguma UBS e para aquelas em consulta de retorno. A automedicação e o uso de medicamentos homeopáticos foram baixos.

Iowa Study of No Passing Zone Signing, 1962

This report is compiled from data gathered by interviewing motorists to sample their opinion of Iowa's method of supplementing the yellow barrier line pavement marking of no passing zones on primary highways with yellow pennant shaped "No Passing Zone" signs mounted on the left shoulder of the highway. The effective designation of no passing zones is one form of control that can contribute to a reduction in the number of fatal high-speed head-on collisions resulting from passing in areas which do not afford sufficient sight distance of approaching traffic. It is the purpose of this report to present an evaluation of the Iowa "No Passing Zone" sign by individuals from all states who have traveled on Iowa's primary highways and who must obey the no passing zone restrictions and be warned by this sign of the presence of the zones. The "No Passing Zone" sign was formulated and approved by the Governor's Safety Committee a short time prior to the experimental erection of the signs. The Governor's Safety Committee adopted this sign as they felt that such a sign should be distinctive (not similar to any other type of sign) and easily visible to a driver attempting a passing maneuver.

Strategies for partner notification for sexually transmitted infections, including HIV

BACKGROUND Partner notification (PN) is the process whereby sexual partners of an index patient are informed of their exposure to a sexually transmitted infection (STI) and the need to obtain treatment. For the person (index patient) with a curable STI, PN aims to eradicate infection and prevent re-infection. For sexual partners, PN aims to identify and treat undiagnosed STIs. At the level of sexual networks and populations, the aim of PN is to interrupt chains of STI transmission. For people with viral STI, PN aims to identify undiagnosed infections, which can facilitate access for their sexual partners to treatment and help prevent transmission. OBJECTIVES To assess the effects of different PN strategies in people with STI, including human immunodeficiency virus (HIV) infection. SEARCH METHODS We searched electronic databases (the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE) without language restrictions. We scanned reference lists of potential studies and previous reviews and contacted experts in the field. We searched three trial registries. We conducted the most recent search on 31 August 2012. SELECTION CRITERIA Published or unpublished randomised controlled trials (RCTs) or quasi-RCTs comparing two or more PN strategies. Four main PN strategies were included: patient referral, expedited partner therapy, provider referral and contract referral. Patient referral means that the patient notifies their sexual partners, either with (enhanced patient referral) or without (simple patient referral) additional verbal or written support. In expedited partner therapy, the patient delivers medication or a prescription for medication to their partner(s) without the need for a medical examination of the partner. In provider referral, health service personnel notify the partners. In contract referral, the index patient is encouraged to notify partner, with the understanding that the partners will be contacted if they do not visit the health service by a certain date. DATA COLLECTION AND ANALYSIS We analysed data according to paired partner referral strategies. We organised the comparisons first according to four main PN strategies (1. enhanced patient referral, 2. expedited partner therapy, 3. contract referral, 4. provider referral). We compared each main strategy with simple patient referral and then with each other, if trials were available. For continuous outcome measures, we calculated the mean difference (MD) with 95% confidence intervals (CI). For dichotomous variables, we calculated the risk ratio (RR) with 95% CI. We performed meta-analyses where appropriate. We performed a sensitivity analysis for the primary outcome re-infection rate of the index patient by excluding studies with attrition of greater than 20%. Two review authors independently assessed the risk of bias and extracted data. We contacted study authors for additional information. MAIN RESULTS We included 26 trials (17,578 participants, 9015 women and 8563 men). Five trials were conducted in developing countries. Only two trials were conducted among HIV-positive patients. There was potential for selection bias, owing to the methods of allocation used and of performance bias, owing to the lack of blinding in most included studies. Seven trials had attrition of greater than 20%, increasing the risk of bias.The review found moderate-quality evidence that expedited partner therapy is better than simple patient referral for preventing re-infection of index patients when combining trials of STIs that caused urethritis or cervicitis (6 trials; RR 0.71, 95% CI 0.56 to 0.89, I(2) = 39%). When studies with attrition greater than 20% were excluded, the effect of expedited partner therapy was attenuated (2 trials; RR 0.8, 95% CI 0.62 to 1.04, I(2) = 0%). In trials restricted to index patients with chlamydia, the effect was attenuated (2 trials; RR 0.90, 95% CI 0.60 to 1.35, I(2) = 22%). Expedited partner therapy also increased the number of partners treated per index patient (three trials) when compared with simple patient referral in people with chlamydia or gonorrhoea (MD 0.43, 95% CI 0.28 to 0.58) or trichomonas (MD 0.51, 95% CI 0.35 to 0.67), and people with any STI syndrome (MD 0.5, 95% CI 0.34 to 0.67). Expedited partner therapy was not superior to enhanced patient referral in preventing re-infection (3 trials; RR 0.96, 95% CI 0.60 to 1.53, I(2) = 33%, low-quality evidence). Home sampling kits for partners (four trials) did not result in lower rates of re-infection in the index case (measured in one trial), or higher numbers of partners elicited (three trials), notified (two trials) or treated (one trial) when compared with simple patient referral. There was no consistent evidence for the relative effects of provider, contract or other patient referral methods. In one trial among men with non-gonococcal urethritis, more partners were treated with provider referral than with simple patient referral (MD 0.5, 95% CI 0.37 to 0.63). In one study among people with syphilis, contract referral elicited treatment of more partners than provider referral (MD 2.2, 95% CI 1.95 to 2.45), but the number of partners receiving treatment was the same in both groups. Where measured, there was no statistical evidence of differences in the incidence of adverse effects between PN strategies. AUTHORS' CONCLUSIONS The evidence assessed in this review does not identify a single optimal strategy for PN for any particular STI. When combining trials of STI causing urethritis or cervicitis, expedited partner therapy was more successful than simple patient referral for preventing re-infection of the index patient but was not superior to enhanced patient referral. Expedited partner therapy interventions should include all components that were part of the trial intervention package. There was insufficient evidence to determine the most effective components of an enhanced patient referral strategy. There are too few trials to allow consistent conclusions about the relative effects of provider, contract or other patient referral methods for different STIs. More high-quality RCTs of PN strategies for HIV and syphilis, using biological outcomes, are needed.

SONIA REGINA PRADO

A dissertação teve como objetivo principal estudar como uma Instituição de Ensino Superior Privada (IES) atuante no Brasil tem crescido pós Lei de Diretrizes e Bases (LDB) de 1996 até 2015, por meio da análise do curso de bacharelado em Administração de Empresas, nas modalidades: presencial, EAD e Flex (semipresencial). Para este fim, foi realizada uma pesquisa exploratória, de caráter qualitativo baseada no método do estudo de caso. Para coleta de evidências foram analisados relatórios corporativos (Annual Report, Relatórios Internos e outros documentos), entrevistas baseadas em roteiro semiestruturado com gestores da IES privada e observações. Dentre os principais achados, verificou-se que as principais estratégicas de crescimento da IES privada estudada se basearam em fusões e aquisições de outras IES, abertura de novos polos de EAD, na abertura de novas unidades próprias, bem como em inovações em várias dimensões da organização. Os programas governamentais de financiamento aos alunos também são fortes contribuintes para este crescimento, como o Fundo de Financiamento ao Estudante do Ensino Superior (FIES) e o Programa Universidade para Todos (Prouni). Com essa nova realidade, o ensino superior privado recebeu incentivo e facilitação para o seu crescimento, a um ritmo acelerado. Consequentemente pode-se concluir que a IES privada estudada adotou as seguintes estratégias de crescimento: Expansão orgânica com fusões/ aquisições de Instituições menores, com desenvolvimento de planos para todos os campi Brasil; Greenfield (por meio de solicitação de autorização de novas unidades e/ou cursos) em cidades sem possibilidades de aquisições/fusões, e aumentando o número de vagas/ matriculas nas unidades já existentes, aderiu aos programas do governo e também cuidou da evasão por meio de: Seguro educacional; gestão preparada para atender necessidades do discente; Sistema de Ensino com currículos integrados nacionalmente; Intercâmbio de alunos e professores entre as diversas unidades em todas as regiões do país e padronização dos processos.

ESTRATÉGIAS DE EXPANSÃO DE INSTITUIÇÕES DE ENSINO SUPERIOR PRIVADAS NO BRASIL: ESTUDO DE CASO DO CURSO DE BACHARELADO EM ADMINISTRAÇÃO

A dissertação teve como objetivo principal estudar como uma Instituição de Ensino Superior Privada (IES) atuante no Brasil tem crescido pós Lei de Diretrizes e Bases (LDB) de 1996 até 2015, por meio da análise do curso de bacharelado em Administração de Empresas, nas modalidades: presencial, EAD e Flex (semipresencial). Para este fim, foi realizada uma pesquisa exploratória, de caráter qualitativo baseada no método do estudo de caso. Para coleta de evidências foram analisados relatórios corporativos (Annual Report, Relatórios Internos e outros documentos), entrevistas baseadas em roteiro semiestruturado com gestores da IES privada e observações. Dentre os principais achados, verificou-se que as principais estratégicas de crescimento da IES privada estudada se basearam em fusões e aquisições de outras IES, abertura de novos polos de EAD, na abertura de novas unidades próprias, bem como em inovações em várias dimensões da organização. Os programas governamentais de financiamento aos alunos também são fortes contribuintes para este crescimento, como o Fundo de Financiamento ao Estudante do Ensino Superior (FIES) e o Programa Universidade para Todos (Prouni). Com essa nova realidade, o ensino superior privado recebeu incentivo e facilitação para o seu crescimento, a um ritmo acelerado. Consequentemente pode-se concluir que a IES privada estudada adotou as seguintes estratégias de crescimento: Expansão orgânica com fusões/ aquisições de Instituições menores, com desenvolvimento de planos para todos os campi Brasil; Greenfield (por meio de solicitação de autorização de novas unidades e/ou cursos) em cidades sem possibilidades de aquisições/fusões, e aumentando o número de vagas/ matriculas nas unidades já existentes, aderiu aos programas do governo e também cuidou da evasão por meio de: Seguro educacional; gestão preparada para atender necessidades do discente; Sistema de Ensino com currículos integrados nacionalmente; Intercâmbio de alunos e professores entre as diversas unidades em todas as regiões do país e padronização dos processos.

Measuring the assessment and counselling provided with the supply of non-prescription asthma reliever medication: a simulated patient study

BACKGROUND: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking. OBJECTIVE: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. METHODS: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. RESULTS: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02). CONCLUSIONS: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.