Pharmacy Owners Research Articles

Pharmacists' practices for non-prescribed antibiotic dispensing in Mozambique.

Background:Antibiotics are the most frequently used medicines worldwide with most of the countries defining these as prescription-only medicines. Though, dispensing non-prescribed antibiotics represent one of the chief causal factors to the irrational use of antibiotics that paves the way to the development of antimicrobial resistance.Objective:We aimed at describing the practices and the enablers for non-prescribed antibiotic dispensing in Maputo city, Mozambique.Methods:A qualitative study was conducted, between October 2018 and March 2019, in nine private pharmacies randomly selected across Maputo city. Eighteen pharmacists were contacted and seventeen enrolled through snowball sampling. In-depth interviews were conducted, audiotaped, and transcribed verbatim. Transcripts were coded and analysed though thematic analysis with guidelines from Braun and Clark. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong, 2007) was performed.Results:Out of seventeen, fifteen pharmacists admitted non-prescribed dispensing of antibiotics. Common antibiotic dispensing practices included; dispensing without prescription, without asking for a brief clinical history of patients, without clear explanation of the appropriate way of administering, without advising on the side effects. Reasons for non-prescribed antibiotic dispensing are linked to patients’ behaviour of demanding for non-prescribed antibiotics, to the patients expectations and beliefs on the healing power of antibiotics, to the physicians’ prescribing practices. Other reasons included the pressure for profits from the pharmacy owners, the fragile law enforcement, and absence of accountability mechanisms.Conclusions:The practices of non-prescribed antibiotic dispensing characterize the ‘daily life’ of the pharmacists. On the one hand, the patient’s demand for antibiotics without valid prescriptions, and pharmacist’s wish to assist based on their role in the pharmacy, the pressure for profits and on the understanding of the larger forces driving the practices of self-medication with antibiotics - rock. On the other hand, pharmacists are aware of the legal status of antibiotics and the public health consequences of their inappropriate dispensing practices and their professional and ethical responsibility for upholding the law - hard place. Highlighting the role of pharmacists and their skills as health promotion professionals is needed to optimizing antibiotic dispensing and better conservancy in Mozambique.

Nearly half of pharmacy owners ‘actively looking’ to buy another pharmacy, survey finds

Nearly half of pharmacy owners ‘actively looking’ to buy another pharmacy, survey finds

Real Work Conditions of Pharmaceutic Servantsat the Beginning of the XX Century (Review)

Introduction. At the beginning of the twentieth century in the pharmaceutical community of Russia there were many problems. On the pages of the special press, such problems as the organization of pharmacy institutions (pharmacies, warehouses, shops, manufactures), directions and prospects for the development of the domestic pharmaceutical industry, its information support, relations within the pharmaceutical community, and the history of the development of world and domestic pharmaceutical science were discussed. However, more and more the subject of discussion was issues related to the fact of the extremely difficult situation of pharmacists-employees.Text. The paper presents an analysis of the report of B. N. Saltykova «On the need to reduce working hours in pharmacies.» In it, the author presented a detailed and impartial analysis of the activities of pharmacies in the early twentieth century, summarized and formulated claims of pharmacists to government departments, pharmacy owners and the entire pharmaceutical community, substantiating, in particular, the need to reduce the working hours of pharmacy employees.Conclusion. A detailed study of the contents of the report B. N. Saltykova leads to a clear understanding of the acuteness of issues related to unsatisfactory working and living conditions of pharmacists serving in Russian pharmacies at the turn of the 19th and 20th centuries. To solve this problem and establish normal work and life for pharmacists, a systematic approach is needed, as they would say now. In addition to the 8-hour shift and standardization of duties, changes were required at all levels of pharmaceutical education, changes in the legislative sphere, the search for consensus between the pharmacists-owners and pharmacists-employees, the appropriate labor protection of the pharmacist and the improvement of their life, and, most importantly, changes in society’s attitude to the pharmacist, that is, raising the prestige of this profession.

Medication safety problems priorities in community pharmacy in Saudi Arabia: a multi-stakeholder Delphi study using the human factors framework

AimTo achieve multi-stakeholder consensus and prioritisation of medication safety problems in community pharmacies in Saudi Arabia.Design and interventionA theoretically-underpinned, three-round Delphi study.SettingSaudi Arabia.ParticipantsPatients and public (pharmacy users), pharmacy-related professionals (policymakers,...

Evaluation of Managerial Skills among Pharmacists in South of Iran Running Title: Managerial Skills among Pharmacists

Background and purpose: According to the importance of managerial skills in both public and private pharmacies, this study aimed to investigate the managerial skills of technical officers of pharmacies in south of Iran.
 Materials and Methods: This was a cross-sectional study on 124 technical officers and 113 personnel working in the pharmacies in Shiraz in 2017. A researcher-made questionnaire was developed containing demographic questions (age, sex, and work experience), place of study, pharmacy ownership, and type of pharmacy, and 17 other questions to evaluate the managerial skills of the technical officers from their own self-assessment and their personnel viewpoints. The validity of the questionnaire was verified by experts, and its reliability was confirmed by a Cronbach's alpha coefficient of 0.85. Data was analyzed applying SPSS23 through descriptive statistics, Mann-Whitney, and Chi-square tests (α=5%).
 Results: This study showed that from the perspective of the personnel working in pharmacies, the skill of “time management” was in a desirable condition, and the skill of “conflict management” was in an undesirable condition. Based on the results of the self-assessment of technical officers, their managerial skills were significantly related to gender, age, work experience, and pharmacy ownership. Accordingly, the female technical officers under 30 years of age, with a work experience of less than 16 years, who were working in public pharmacies assigned better scores to their managerial skills.
 Conclusion: Based on the findings, it is necessary to improve the managerial skills of technical officers specially their ability of conflict management through appropriate training, and examine the impact of demographic factors and the characteristic of pharmacies on their managerial skills.

Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study.

Background:In Germany over-the-counter medications (OTC) – which since 2004 are no longer subject to binding prices – can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications.Objective:The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient’s approach (symptom-based versus medication-based request) in determining the outcome of these aspects.Methods:A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids.Results:In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an ‘adequate intake of fluids’ in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified – for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53.Conclusions:Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated.

Analysis of Sales Pattern Determination System and Drug Stock Recommendation

The tight competition in the pharmacy industry, requires pharmacy owners to develop strategies in increasing drug sales. One of the strategies carried out is to analyze patterns of drug sales and determine drug stock recommendations based on sales transaction data. Based on this, an application was built to determine the pattern of drug sales and drug stock recommendations by using a modified Apriori Algorithm and Triple Exponential Smoothing Method. Apriori algorithm modification is used to overcome the problem of large amounts of sales transaction data, thus minimizing the time in the database scan process. Triple Exponential Smoothing method is used in determining drug stock recommendations based on sales patterns that have been generated to prevent excess or lack of stock. Application testing techniques used are performance testing, lift ratio and accuracy testing. The research resulted in a sales pattern that has a strong association rule and time analysis using Apriori Algorithm modification that is faster than using a traditional Apriori Algorithm and the percentage error value of drug stock recommendations by 31.84%.&#x0D; Keywords: Sales Pattern, Stock Recommendations, Apriori Algorithm Modification and Triple Exponential Smoothing

Organisational factors associated with safety climate, patient satisfaction and self-reported medicines adherence in community pharmacies.

Evidence suggests that community pharmacy service quality varies, and that this may relate to pharmacy ownership. However little is known about wider organisational factors associated with quality. To investigate organisational factors associated with variation in safety climate, patient satisfaction and self-reported medicines adherence in English community pharmacies. Multivariable regressions were conducted using data from two cross-sectional surveys, of 817 pharmacies and 2124 patients visiting 39 responding pharmacies, across 9 diverse geographical areas. Outcomes measured were safety climate, patient satisfaction and self-reported medicines adherence. Independent variables included service volume (e.g. dispensing volume), pharmacy characteristics (e.g. pharmacy ownership), patient characteristics (e.g. age) and areal-specific demographic, socio-economic and health-needs variables. Valid response rates were 277/800 (34.6%) and 971/2097 (46.5%) for pharmacy and patient surveys respectively. Safety climate was associated with pharmacy ownership (F8,225 = 4.36, P < 0.001), organisational culture (F4, 225 = 12.44, P < 0.001), pharmacists' working hours (F4, 225 = 2.68, P = 0.032) and employment of accuracy checkers (F4, 225 = 4.55, P = 0.002). Patients' satisfaction with visit was associated with employment of pharmacy technicians (β = 0.0998, 95%CI = [0.0070,0.1926]), continuity of advice-giver (β = 0.2593, 95%CI = [0.1251,0.3935]) and having more reasons for choosing that pharmacy (β = 0.3943, 95%CI = [0.2644, 0.5242]). Satisfaction with information received was associated with continuity of advice-giver (OR = 1.96, 95%CI = [1.36, 2.82]), weaker belief in medicines overuse (OR = 0.92, 95%CI = [0.88, 0.96]) and age (OR = 1.02, 95%CI = [1.01, 1.03]). Regular deployment of locums by pharmacies was associated with poorer medicines adherence (OR = 0.50, 95%CI = [0.30, 0.84]), as was stronger patient belief in medicines overuse (OR = 0.88, 95%CI=[0.81, 0.95]) and younger age (OR = 1.04, 95%CI = [1.01, 1.07]). No patient outcomes were associated with pharmacy ownership or service volume. This study characterised variation in the quality of English community pharmacy services identifying the importance of skill-mix, continuity of care, pharmacy ownership, organisational culture, and patient characteristics. Further research is needed into what constitutes and influences quality, including the development of validated quality measures.

Views on the role of community pharmacy in local communities: a case study of stakeholders' attitudes.

Objectives:To investigate the view of the role of community pharmacy by selected stakeholders in local Danish communities.Methods:A mixed method approach combining qualitative and quantitative methods was used: observations at pharmacies, questionnaires for pharmacy staff and customers, and interviews with pharmacy owners, general practitioners (GPs) and politicians. Role theory was the theoretical foundation. Data was analyzed using directed content analysis and descriptive statistics.Results:Five Danish towns were visited, resulting in five pharmacist interviews, 48 questionnaire replies from pharmacy staff, 59 customer interviews, three GP interviews and four interviews with local politicians. All stakeholders found the pharmacy to have a medical focus, although to a differing degree. While pharmacy staff and GPs had the greatest knowledge and expectations regarding the pharmacy staff’s level of medical knowledge, local politicians had the least. Pharmacy staff wanted to take on more responsibility. Customers generally considered the pharmacy part of the healthcare sector with a high level of knowledge on medications. GPs’ attitudes appeared to be related to the amount of communication between GP office and pharmacy. Local politicians interviewed did not seem to be aware of the competencies within the pharmacy, but once informed were open to using the pharmacy as an integrated part of the local healthcare system.Conclusions:There was general consensus between stakeholder groups that medicine is the main area of focus at the pharmacy. However, investigated stakeholders did not appear to be aware of the full extent of the competencies within the pharmacy, and there was a general lack of consensus about the services the pharmacy should perform. If the competencies within the pharmacy are to be fully utilized, the pharmacy must not only tell but also show the local community what they can do.

Health workforce planning in Namibia: assessing a pilot workforce survey of pharmacists.

Southern Africa lacks resources necessary to combat presenting health challenges. This crisis will likely be remedied through the in-country training of healthcare professionals, for example, in Namibia. Monitoring the workforce will be essential to inform planning in health services and training. A national pilot workforce survey in Namibia using a multi-modal sampling approach aimed to test methodology for describing the pharmacy workforce and quantifying preferences towards further training. The survey tool included questions relating to socio-demographics, professional and practice aspects. A conjoint analysis approach was utilised to quantify preferences around study programme, modality of study and cost. Respondents (N=135; ~20% response) represented a diverse range of individuals in various pharmacy sectors in Namibia. The majority of respondents reported female gender, private sector working, studying outside Namibia and societal group membership. Societal membership and pharmacy ownership - indicators of professional engagement - were associated with higher age; ownership was also associated with study outside Namibia and practice in community pharmacy. Regarding further study preferences, respondents placed more importance on study programme and modality over cost with the most preferred scenario being a 2-year full-time Masters programme in pharmaceutical industry/regulation by distance learning at the highest cost bracket. This national survey sampled the population of pharmacists in Namibia exploring the composition of the profession and preferences towards training. Further work will validate the findings and provide ongoing monitoring of the pharmacy workforce that can be expanded to other professional groups over a larger geographical area.

Pharmacies and the Pharmaceutical Industry in Latin America

Latin American community pharmacies treat large segments of the population, especially the poor. Self‐medication rates are high, and prescription‐only medicines are often available without a prescription. Patients rely more on pharmacists’ advice than clinicians’, but conflicts of interest are rampant: companies may offer discounts, extra drugs, or a higher profit margin to pharmacy owners; pharmacy staff recommendations may be compromised by lack of education or financial incentives, including bonuses and commissions for recommending specific drugs. Pharmacists and staff rely on pharmaceutical company education on drugs. Pharmacy chains, which tend to provide poorer service, are replacing family owned pharmacies in most Latin American countries. Pharmacies are a de facto safety net for the poor and uninsured and should be considered part of the health‐care system, not just commercial establishments. Medicine dispensation should be professionalized, and pharmaceutical company‐funded education should be banned to minimize the conflicts of interest that affect medication recommendations.

Exploring the implementation of a novel optimizing care model in the community pharmacy setting

ObjectivesThe primary objective of this study was to identify and summarize the perspectives of managers, pharmacists, and pharmacy technicians regarding the implementation of the Optimizing Care Model and corresponding task delegation of final product verification to pharmacy technicians in the community pharmacy. A secondary objective was to better understand successes and concerns in implementing the model. DesignThis qualitative research study employed the use of semistructured interviews. The authors served as coders and analyzed the transcripts with the use of inductive and deductive thematic analysis. Setting and participantsKey informants included managers, pharmacists, and pharmacy technicians participating in the Optimizing Care Model in community pharmacies across both chain and independent pharmacy settings in Iowa, Tennessee, and Wisconsin. Interviews were conducted via telephone. ResultsThe research team interviewed 14 participants. Six themes were identified: The Optimizing Care Model catalyzes patient care service delivery expansion in the community pharmacy setting, effectiveness is driven by “freed-up” pharmacist time compared with the traditional model, the model positively affects roles and job satisfaction of pharmacy personnel, technician engagement and ownership have a strong impact on the success and ramifications of the model, significant changes to pharmacy operations are necessary for successful implementation, and there are several factors ensuring successful implementation and sustaining of the Optimizing Care Model. ConclusionVarious participants (pharmacists, managers, technicians) in a technician product verification program known as the Optimizing Care Model agreed that patient care delivery can be enhanced through the task delegation of final product verification to pharmacy technicians. Additional positive impacts on organizational and individual level outcomes were found, which included quality of work life, engagement, and commitment.

Diversity as salvation? – A comparison of the diversity rationale in the Swedish pharmacy ownership liberalization reform and the primary care choice reform

Widespread liberalizing reform of the Swedish community pharmacy and primary care sectors took place in 2009–2010, including opening the market to private providers. One important rationale for the reforms was to increase diversity in the health-care system by providing more choices for individuals. The aim of this study was to increase the understanding how policy makers understood and defined diversity as a concept, and as a rationale for the reforms. The method used was document analysis of preparatory work and plenary parliament debate protocols. The results show that policy makers held vague and unclear definitions of diversity, which complicated its implementation. Diversity was sometimes seen as an effect of competition–a goal–while in other cases it was seen as a condition to be met in order to achieve competition–a means. Thus, policy makers viewed diversity both as a goal and as a means, making the underlying mechanisms unclear. The findings also revealed that policy makers failed to consistently demonstrate how the introduction of competition would lead to diversity.

Pharmacy Practice and Education in Finland.

The Pharmacy Education in Europe (PHARMINE) project studies pharmacy practice and education in the European Union (EU) member states. The work was carried out using an electronic survey sent to chosen pharmacy representatives. The surveys of the individual member states are now being published as reference documents for students and staff interested in research on pharmacy education in the EU, and in mobility. This paper presents the results of the PHARMINE survey on pharmacy practice and education in Finland. Pharmacies have a monopoly on the dispensation of medicines. They can also provide diagnostic services. Proviisori act as pharmacy owners and managers. They follow a five-year (M.Sc. Pharm.) degree course with a six-month traineeship. Farmaseutti, who follow a three-year (B.Sc. Pharm.) degree course (also with a six-month traineeship), can dispense medicines and counsel patients in Finland. The B.Sc. and the first three years of the M.Sc. involve the same course. The current pharmacy curriculum (revised in 2014) is based on five strands: (1) pharmacy as a multidisciplinary science with numerous opportunities in the working life, (2) basics of pharmaceutical sciences, (3) patient and medication, (4) optional studies and selected study paths, and (5) drug development and use. The learning outcomes of the pharmacy graduates include (1) basics of natural sciences: chemistry, physics, technology, biosciences required for all the students (B.Sc. and M.Sc.), (2) medicine and medication: compounding of medicines, holism of medication, pharmacology and biopharmaceutics (side-effects and interactions), patient counseling, efficacy and safety of medicines and medication, (3) comprehensive and supportive interactions of the various disciplines of pharmacy education and research: the role and significance of pharmacy as a discipline in society, the necessary skills and knowledge in scientific thinking and pharmaceutical research, and (4) basics of economics and management, multidisciplinarity, hospital pharmacy, scientific writing skills, management skills. In addition, teaching and learning of “general skills”, such as the pharmacist’s professional identity and the role in society as a part of the healthcare system, critical and creative thinking, problem-solving skills, personal learning skills and life-long learning, attitude and sense of responsibility, and communication skills are developed in direct association with subject-specific courses. Professional specialization studies in industrial pharmacy, and community and hospital pharmacy are given at the post-graduate level at the University of Helsinki.

Attitudes, Practices, and Barriers of Malaysian Community Pharmacists Toward Provision of Weight Management Services.

In Malaysia, sharp increment in the prevalence of obesity over the last four decades has been documented. Community pharmacists (CPs) are strategically placed to tackle obesity by providing weight managements services (WMS) to general public. This study assessed the attitudes, practices and perceived barriers of Malaysian CPs to the provision of WMS. A cross-sectional, descriptive survey was conducted, and responses related to attitudes, practices and perceived barriers of CPs were collected using five-point Likert scale. A total of 550 pharmacists who worked across six states of Malaysia (Selangor, Federal Territory of Kuala Lumpur, Pulau Pinang, Johor, Sabah, and Melaka) participated in this study. Most of the CPs strongly agreed that over eating (n = 312, 56.7%) and sedentary lifestyles (n = 297, 54.0%) contribute to obesity and overweight. Most of them also strongly agreed that exercise training is an effective weight reduction strategy (n = 285, 51.9%), but they were generally not in favor of surgery (n = 231, 42% disagreed/strongly disagreed). CPs generally perceived barriers related to a lack of staff to provide WMS (n = 308, 56.0% agreed/strongly agreed) and ethical and legal issues associated with sales of products/drugs for obesity management (n = 285, 51.9% agreed/strongly agreed). Sociodemographic and practice characteristics such as age group, type of pharmacy, highest education qualification, and employment status of CPs influenced the attitudes, practices and perceived barriers associated with WMS. In terms of age, CPs who were aged less then 30 years expressed significantly stronger agreement that medication adherence is beneficial for weight loss compared to those CPs between 41–50 years. Additionally, CPs who were pharmacy owners provided significantly more frequent BMI measurement and patient information materials as part of their weight management practices compared to CPs who worked as a part timer/locum. This study could be taken as a baseline study on Malaysian CPs’ perceptions on WMS.

Influence of strategic planning on product marketing and health service orientation of community pharmacies—A national survey in Finland

The aim of this study was to explore pharmacy owners’ views on the strategic development of community pharmacies, particularly how strategic planning at the pharmacy level influences on product marketing and health service orientation of individual community pharmacies.The study was carried out as a national cross-sectional e-mail survey sent to all privately-owned Finnish community pharmacies (n = 581) in March 2013 (response rate 34%, n = 198). The pharmacy owners were asked about their strategy, product marketing and health services activities at the time of the survey and what they regarded as potential strategic developments by 2020.Of the responding pharmacy owners (n = 198), 63% reported their pharmacy had a strategy. The strategy was more common if the pharmacy owner had >10 years of experience as a pharmacy owner, the pharmacy had a high prescription volume (annually >100,000 prescriptions) and sales volume (annual turnover >5 million euros). Pharmacy owners’ strategic vision by 2020 concerning health service orientation was the same regardless of having a strategy. Having a strategy was associated with the following variables indicating active product marketing orientation: the pharmacy had a person responsible for marketing campaigns and monitoring their success, and the pharmacy actively invested in add-on sales. Economic uncertainty of community pharmacies is an unresolved issue driving them towards active product marketing even they strategically prioritized health service orientation.

Implementation of an interprofessional medication adherence program for chronic patients in community pharmacies: how much does it cost for the provider?

BackgroundThe implementation of an innovative and sustainable professional pharmacy service in routine care requires substantial resources borne by the pharmacy owner. Although a community pharmacy is a business setting, few studies have examined cost as a potential barrier to widespread implementation. Implementation costs, as the cost impact of an implementation effort, can be significant and hamper the decision to invest from the provider perspective. Traditional financial planning tools can be used to analyse and support business decision to implement a service by assessing the net impact of a new service on the provider’s budget. This study aimed to estimate the implementation costs and the break-even point of an interprofessional medication adherence program for chronic patients in Switzerland. The program combines motivational interviews, medication adherence electronic monitoring and feedback reports to patient and physicians.MethodsWe used a 3-step approach: (i) micro-costing analysis: identification of implementation activities, quantification and valuation of required resources. Implementation costs, including service support costs and direct delivery costs, were analysed according to the implementation phase (installation, initial implementation, and full operation); (ii) break-even analysis: estimation of the required number of patients to follow up with to ensure that the generated revenue exceeded the total cost; and (iii) univariate sensitivity analyses.ResultsThe estimated total cost of the installation phase was 8481 CHF, more than half of which represented the cost of the equipment. Direct delivery costs were 666 CHF per patient per year, with 68% of this value associated with the cost of workforce time. According to the Swiss national reimbursement system, a minimal of 16 [10–27] patients was required to cover the implementation costs of the installation phase. This break-even point decreased to 13 patients in the initial and full operation phases.ConclusionsThese estimates lead to a better understanding of the real cost of implementing a professional pharmacy service in routine care. In a Swiss context, the current medication adherence support fee-for-service system allows pharmacists to reach the break-even point. Such information is important for community pharmacists to guide their implementation strategies. The replication of similar analyses in other settings and countries is paramount.

The Urgency of Law Enforcement of Illegal Medicine Distributions in Indonesia

Background: Medicine plays an important role and is an irreplaceable component in health. World Health Organization (WHO) statistics in 2015 stated that illegal medicine distributions in Indonesia are not less than 3 trillion rupiahs per year or 10 percent of all existing medicine distributions. These findings indicate that law enforcement against criminal acts of illegal medicines distribution is still not adequate. The distribution of illegal medicines including counterfeit medicines is a serious threat to the health of all Indonesian people. This study aimed to analyze the urgency of law enforcement of illegal medicine distribution in Indonesia. Subjects and Method: This was a qualitative study (descriptive non-doctrinal legal research) conducted in Sragen, Central Java. Five informants consist of the head of Loka BPOM Surakarta, the head of Sragendistric health office, a hospital director, a pharmacist in a community health center, and a pharmacy owner. Data collected by interview, observation, and documentary review. Data were analyzed by data reduction, presentation, and verification. Results: The investigations of the distribution of illegal medicines are carried out by PPNS from BPOM and accompanied by the police as supervisory coordinators. BPOM has a mapping of facilities and cases, as well as information from the community. If there is sufficient evidence, BPOM applies administrative sanctions, and if there is a criminal sanction, it will continue to other law enforcement officers. The regulations in the field of medicine are adequate, starting from Law number 36 of 2009 concerning Health, government regulations, the minister of health regulations, and BPOM regulations. The distribution of illegal medicines still occurs because there are demands from community and online medicine sales that have not been regulated by the government. Conclusion: Based on Lawrence M. Friedman’s theory, a legal substance, legal structure, and legal culture are a unity in carrying out law enforcement efforts, meaning that no matter how good a law is if it is not accompanied by a good implementing structure and a supportive culture it will be difficult to enforce the law. The society’s trust in the law enforcement officers in Indonesia that considered low should be restored with some improvement in structural and substantial aspects of law along with the presence of legal culture. Keywords: medicine, pharmacy, distribution, illegal Correspondence: Evelina Yuliani. Masters Program in Law, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: eyuliani12@gmail.com. Mobile: 0811285066. Journal of Health Policy and Management (2019), 4(2): 76-85 https://doi.org/10.26911/thejhpm.2019.04.02.01

Adapting the Auckland Sleep Screening Tool for pharmacy: pharmacists' experience and feedback.

INTRODUCTION Insomnia has negative health effects and may indicate underlying serious conditions, but is underdiagnosed and often not discussed with a doctor. AIM This study aimed to explore the utility and workability in New Zealand community pharmacies of a 23-question sleep-screening tool adapted from the Short Auckland Sleep Questionnaire. METHODS A multidisciplinary advisory group (sleep specialist, general practitioner and pharmacists) discussed the tool, pharmacists' capability in managing insomnia and training needs for pharmacists, and recommended management strategies, including referral points. Twelve community pharmacists piloted the tool with people with insomnia who presented in pharmacies, recording the time it took to administer the tool. The pharmacists were then surveyed about their experiences with the tool and possible improvements. RESULTS Ten pharmacists took an average of 12.4 min (range 4-35 min) for each use of the screening tool with 62 people with insomnia. Most pharmacists found the screening tool easy to administer, organised and easy to follow and nine of 10 said it provided better information than their usual consultation. Seven of 10 pharmacists would use it again. Time limitations and low recruitment were potential barriers to usage especially for pharmacy owners. DISCUSSION The screening tool could provide a useful addition to pharmacists' toolkits, aiding information gathering and better than usual practice. The tool was acceptable to most pharmacists, but its use takes time and remuneration needs consideration.

The Tricare Fraud: A Case Study in Data Analytics for Healthcare Fraud Detection

Healthcare fraud is a huge problem in the United States and around the world. In fiscal year 2016, the U.S. Department of Justice recovered $2.5 billion in settlements and judgments from civil cases involving fraud and false claims related to the healthcare industry (DOJ, 2016a). Government agencies as well as insurers can use data analytics to detect health care fraud. The Tricare case is a recent example of healthcare fraud, and involved a dozen doctors, pharmacy owners and marketing professionals who were indicted over a complex scheme involving a fake medical study. Over $100 million was stolen from Tricare (the federal health program for veterans and their families). This case allows students to learn about health care fraud and its prevention, the role of the auditor, and the increasing use of data analytics in fraud prevention and detection.