Public Pharmacies Research Articles

Availability, Price and Affordability of Psychotropic Medicines in Addis Ababa, Ethiopia.

Access to affordable, quality-assured essential medicines is crucial to reduce the burden of disease. However, one third of the world's population lacks regular access to essential medicines. The purpose of this study was to assess the availability, price, and affordability of medicines for mental disorders in Addis Ababa, Ethiopia. A cross-sectional study was done in selected pharmacies after modification of a WHO/HAI methodology developed questionnaire. Data on the availability and price of 28 lowest priced generics and originator brand essential psychotropic medicines were collected from seven public sectors, five private sectors, and seven other sectors (five Kenema Public Community Pharmacies and two Red Cross Pharmacies) in Addis Ababa between May 9 and May 31, 2022. The data were analyzed using the developed WHO/HAI workbook part I Excel sheet. Descriptive results were reported in text and table format. The overall availability of lowest-priced generics medication was 41.69%. The availability of lowest-priced generics and originator brand medication was 54.68% and 1.7% in the public pharmacies; 24.14% and 0.0% in private pharmacies; 43% and 0.0% in Red Cross Pharmacies; and 42% and 3.2% in Kenema Public Community Pharmacies. The median price ratio in the public, private, Red Cross, and Kenema Public Community pharmacies was 1.26, 3.72, 1.65, and 1.59, respectively. Most of the medications were unaffordable. A patient could be required to pay up to 73 days wages to purchase a standard treatment for 1 month. The availability of psychotropic medicines was lower than the WHO target for non-communicable diseases and most of the available medicines were unaffordable.

Totally devoted to you: A qualitative study examining the experiences of sacrifice among pharmacists in rural and regional areas.

The health of rural and regional communities is routinely identified as poor and access to healthcare services is often limited. Rural and regional pharmacists are well placed to deliver a variety of high-quality services to their community, however there is a limited examination of the complexities of their role in rural contexts. This study seeks to examine the types of personal sacrifices and what impact these may have among pharmacists working in rural and regional communities of Australia. A qualitative approach was adopted to examine the experiences of pharmacists working in public health service and private community pharmacies across 13 rural communities in Australia. Purposive sampling was used to recruit pharmacists as part of a larger study examining the efficacy of a workforce recruitment tool (PharmCAQ). As part of the development of the tool, a one-on-one interview were conducted. A total of 20 participants were recruited. Two major themes emerged: Above all the community and More than just a script monkey that embodies the experiences of pharmacists. Centred around self-sacrifice, the first theme captures the tension that is experienced by these professionals as they tread an unsustainable path for the benefit of the community. The second theme provides some insights into the complex nature of the rural and regional context that is juxtaposed with that of their urban counterparts. Pharmacist in rural and regional areas offer a highly skilled and accessible resource to better address the growing needs of those living in rural and regional areas. Despite the opportunities that exist to expand the role of pharmacists in these areas and to capitalise on their expertise, there is a growing need to find ever better ways to support those who support others.

Disponibilité et accessibilité financière aux moyens diagnostiques et thérapeutiques de l’asthme et de la bronchopneumopathie chronique obstructive dans la ville de Ouagadougou, Burkina Faso

Chronic respiratory diseases, particularly asthma and Chronic Obstructive Pulmonary Disease (COPD), pose a significant threat to public health. This study aims to determine the accessibility and affordability of means of diagnosis and treatment. This was a cross-sectional study covering the period from August to December 2021 in Ouagadougou, Burkina Faso. This study involved 107 health centers and 135 pharmacies. The World Health Organization/Health Action International definition was used as a benchmark for accessibility to medicines. Out of 107 health centers, 29 (27.1%) had a spirometer. The average cost of spirometry represented 19.88 days of salary for a patient paid at the minimum wage. The most widely available drugs were salbutamol in a pressurized metered dose inhaler (pMDI) (88.1%) and prednisone 20mg tablet (87.4%). No disease-modifying drug was available in public pharmacies. Affordable drugs were salbutamol 4mg tablet and aminophylline 100mg tablet. The means of diagnosis and treatment of asthma and COPD are insufficiently available, especially in the public sector, which is characterized by a nearly total absence of basic treatment.

Continuity of CVD treatment during the COVID-19 pandemic: evidence from East Java, Indonesia

BackgroundIn Indonesia, the world's fourth most populous country, cardiovascular diseases (CVDs) are a leading cause of death and disability. Government efforts to reduce the burden of CVD include a community-based prevention and early detection programme, and the provision of medicines to prevent cardiovascular events. Disruptions to medicine supply chains, service provision, and movement during the COVID-19 pandemic potentially threatened the continuity of these efforts. We investigated the distribution and dispensing of common CVD medicines in Malang district, East Java, before the pandemic and early in its course.MethodsFrom January to October 2020, we collected monthly data on stock levels, sales or dispensing volumes, and price for five common CVD medicines (amlodipine, captopril, furosemide, glibenclamide and simvastatin), from a public and a private distributor, and from public health facilities (n = 4) and private pharmacies (n = 2). We further complied monthly data on patient numbers in two primary health centres. We tracked changes in stocks held and volumes dispensed by medicine type and sector, comparing the three months before the local COVID-19 response was mobilised with the subsequent seven months. We conducted interviews with pharmacists (n = 12), community health workers (n = 2) and a supply chain logistics manager to investigate the reasons for observed changes, and to learn details of any impacts or mitigation measures.ResultsThe pandemic affected demand more than supply, causing medicine stocks to rise. Restricted service provision, lock-down measures and fear of infection contributed to a sharp drop in patient numbers and dispensing volumes in the public sector. Meanwhile private sector sales, especially of lower-priced CVD medicines, rose. Community health workers attributed some poor health outcomes to interruption in regular patient check-ups; this interruption was aggravated by formal mitigation policies.ConclusionsFears that COVID-19 would interrupt medicine availability were unfounded in East Java. Public sector patients may have compensated for reduced service access by switching to private pharmacies. Mitigation policies that ignored administrative procedures were not effective.

A qualitative study on female executive pharmacists with convergent roles.

Although women's participation is relatively high in the pharmacist workforce, women remain underrepresented in executive positions. The rate of executive female pharmacists in diversified pharmaceutical areas, from education and research to politics, is recognized as being disproportionately low. In this study, we aimed to explore female executive pharmacists' roles and identify reasons for their being underrepresented in such executive positions in Turkey. Semistructured in-depth interviews were conducted from a feminist standpoint with female executive delegates working in the Grand National Assembly of Turkey, pharmacy chambers, and public pharmacy faculties. A thematic data analysis of transcriptions was conducted using MAXQDA 2020 software and was reported according to Consolidated Criteria for Reporting Qualitative Research. The researchers interviewed 19 participants. Three primary themes emerged: gender roles, being an executive, and being a pharmacist. Eight roles came to the surface: mother, child, wife, pharmacist, manager, homemaker, cook, and planner. Taking the responsibility for an executive position involves a continued and simultaneous performance of all other roles as well. In this context, female pharmacists' views on gender roles in relation to motherhood, inequalities, and their dedication to their profession came to the fore. This study can be considered as a starting point for studying the underlying causes of the limited representation of female pharmacists in executive positions.

Big data analytics in Australian pharmaceutical supply chain

PurposeDrawing on information processing view (IPV) theory, the objective of this study is to explore big data analytics (BDA) in pharmaceutical supply chain (PSC) for better business intelligence. Supply chain operations reference (SCOR) model is used to identify and discuss the likely benefits of BDA adoption in five processes: plan, source, make, deliver and return.Design/methodology/approachSemi-structured interviews with managers in a triad comprising pharmaceutical manufacturers, wholesalers/distributors and public hospital pharmacies were undertaken. NVivo software was used for thematic data analysis.FindingsThe findings revealed that BDA capability would be more practical and helpful in planning, delivery and return processes within PSC. Sourcing and making processes are perceived to be less beneficial.Practical implicationsThe study informs managers about the strategic role of BDA capabilities in SCOR processes for improved business intelligence.Originality/valueAdoption of BDA in SCOR processes within PSC is a step towards resolving the challenges of drug shortages, counterfeiting and inventory optimisation through timely decision. Despite its innumerable benefits of BDA, Australian PSC is far behind in BDA investment. The study advances the IPV theory by illustrating and strengthening the fact that data sharing and analytics can generate real-time business intelligence helping in better health care support through BDA-enabled PSC.

Pharmaceutical waste disposal practices: a case study of an Australian public hospital pharmacy department

AbstractBackgroundIn Queensland, each hospital and health service (local hospital network) has its own waste reduction and recycling plan to comply with the Queensland Government's Waste Reduction and Recycling Act 2011 (Qld). The aim is to reduce both the hospital's carbon footprint and waste handling costs. Hospital environmental waste services staff do not audit pharmaceutical waste bins as this requires the presence of a registered pharmacist.AimSince previous published studies of healthcare waste disposal practices have not included pharmacy waste bin audits, this study aimed to investigate waste disposal behaviours in a hospital pharmacy department.MethodThis sequential, two‐phase mixed methods study was conducted in a metropolitan, tertiary public hospital's pharmacy department in Queensland. Phase I involved semi‐structured interviews of hospital pharmacists and pharmacy technicians while Phase II comprised bin audits of the pharmacy department's waste streams.ResultsThe bin audits revealed 36.1%, 23.8%, and 4.9% of recyclable waste in the clinical waste stream for each of the three bin audits respectively. In the general waste stream, the two bin audits of this stream revealed 14.3% and 44.4%, respectively. The reasons were identified in the interviews: there were no recycling bins in the main dispensing areas and there was confusion surrounding correct disposal of original containers and non‐contaminated packaging waste. Non‐paper waste was found in the confidential (shredded) waste stream in the two bin audits of this stream (10.1% and 16.7%, respectively).ConclusionProvision of commingled recycling bins and clean office paper waste bins in dispensing areas and education of staff on correct waste segregation processes will improve waste segregation in hospital pharmacy departments with both financial and environmental benefits for the hospital and the general population.

Is het chinolonengebruik in België gedaald door de gewijzigde terugbetalingsvoorwaarden van 2018?

Has the use of quinolones in Belgium decreased due to the introduction of reimbursement conditions in 2018? The substantial adverse drug reactions and contribution to antimicrobial resistance of quinolones implore public health initiatives to restrict the usage of these antibiotics. One such initiative in Belgium was to only reimburse quinolones under stringent conditions from May 2018 onwards. In this article, the authors aim to assess the effectiveness of this policy by charting the evolution of quinolone use. This study is based on reimbursement data of quinolones delivered to members of the Christian health insurance fund (CM) in public pharmacies from May 1, 2016 to April 30, 2021. The variables of interest are the number of users and the volume in defined daily dose (DDD). Diagnostic data about members with approval for reimbursement were obtained from the database of the CM, containing authorisations of reimbursement. 19% to 28% of the authorisations were justified as ‘exceptional’ situations without any specific diagnosis. The number of users of reimbursed quinolones decreased by 75% immediately after the implementation of the policy, although a decrease of only 36% was observed in the overall use of quinolones (reconstructed by means of statistics provided by the Belgian society of public pharmacists (APB)). The reimbursement policy in 2018 induced a substantial decrease (75%) in the use of reimbursed quinolones, but also a considerable increase in the use of non-reimbursed quinolones. Although the overall use still has decreased remarkably (36%) since the policy, the decrease was insufficient to reduce the use of quinolones to the objective of 5% of all prescribed antibiotics. In order to keep the quinolone use within reasonable bounds, the authors encourage education of health practitioners, dialogue between medical actors and sensibilisation of users. In addition, this study draws attention to the need for publicly available data on both reimbursed and non-reimbursed medication.

The Howard Street Method: A Community Pharmacy-led Low Dose Overlap Buprenorphine Initiation Protocol for Individuals Using Fentanyl.

Buprenorphine treatment significantly reduces morbidity and mortality for people with opioid use disorder. Fear of precipitated withdrawal remains a barrier to starting buprenorphine for patients who use synthetic opioids, particularly fentanyl. We aim to evaluate the development and implementation of a buprenorphine low dose overlap initiation (LDOI) protocol in an urban public health community pharmacy. We performed a retrospective chart review of patients with nonprescribed fentanyl use (N = 27) to examine clinical outcomes of a buprenorphine LDOI schedule, named the Howard Street Method, dispensed from a community pharmacy in San Francisco from January to December 2020. Twenty-seven patients were prescribed the Howard Street Method. Twenty-six patients picked up the prescription and 14 completed the protocol. Of those who completed the protocol, 11 (79%) reported no symptoms of withdrawal and 3 (21%) reported mild symptoms. Four patients (29%) reported cessation of full opioid agonist use and 10 (71%) reported reduction in their use by the end of the protocol. At 30 days, 12 patients (86%) were retained in care and 10 (71%) continued buprenorphine. At 180 days, 6 patients (43%) were retained in care and 2 (14%) were still receiving buprenorphine treatment. We found that a LDOI blister-pack protocol based at a community pharmacy was a viable intervention for starting buprenorphine treatment and a promising alternative method for buprenorphine initiation in an underresourced, safety-net population of people using fentanyl.

Impact of pharmaceutical teleconsultation on glycemic control of people with type 2 diabetes mellitus in a public pharmacy in Brazil: A randomized clinical trial protocol (TelePharmaceutical Care Diabetes Trial) – TPCDT

Telepharmacy is a fundamental tool to ensure glycemic control in patients who don’t access health services. The objective of this protocol is to report the procedures of a randomized clinical trial that will evaluate the impact and economic evaluation of a pharmaceutical teleconsultation service for patients using dapagliflozin, recently incorporated by the Brazilian public health system for the treatment of type 2 diabetes (T2D). Patients aged 65 years or older, with T2D, and who withdraw dapagliflozin in a public pharmacy located in southern Brazil will be recruited. They will be electronically randomized with allocation for intervention or control group. The intervention will be conducted out through three teleconsultations, one per month, with a pharmacist. The main outcomes will be glycemic control (hemoglobin A1c) and treatment adherence. Secondary outcomes will include lipid profile, blood pressure, and body mass index, number of hospital admissions, number of emergency room visits, number of medical consultations performed, number of problems related to pharmacotherapy identified and resolved, cost related to service and quality of life. The economic evaluation will be carried out using time-driven activity-based costing. Through this research, we will be able to identify whether pharmaceutical teleconsultation services can complement face-to-face consultations to improve health outcomes in T2D patients on dapagliflozin. The study was registered in Clinical Trials (NCT05380596).

Medikationsanalysen in öffentlichen Apotheken: Konzept zur externen Qualitätsüberprüfung

BackgroundA medication review aims at the optimization of medication use, the detection of drug-related problems (DRPs) and the recommendation of interventions. As part of the pilot project “Arzneimittelinitiative Sachsen-Thüringen” (ARMIN) and caused by the introduction of several training programs, numerous public pharmacies in Germany currently offer medication reviews for patients. However, a standardized method for external quality control has so far not been established. MethodsA round robin test for medication reviews was designed in written form by five pharmacists with expertise in different areas (Drug information service ARMIN, Saxonian Chamber of pharmacists, public pharmacy, hospital pharmacy), based on the recommendations of the guideline for medication reviews of the German Federal Chamber of Pharmacists (Bundesapothekerkammer). On the basis of a fictitious case study the participants were asked to check a patient's medication data for the presence of DRPs, propose possible solutions and generate a medication plan. The solutions were assessed by two pharmacists of the drug information service ARMIN on the basis of a best practice solution that had been consented in the study group beforehand. Results102 pharmacists and 13 pharmacy students in internship took part in the round robin test. On average, participants achieved a score of 7,62 out of 9 for recognizing DRPs and recommending solutions and a score of 0,79 out of 1 for generating a correct medication plan. 106 participants (92%) met the requirements for successful participation (recognizing the three most relevant DRPs and at least one further DRP as well as generating an adequate medication plan). The implementation of the approach described here proved to be practicable The State Directorate of Saxony accepted the round robin test as a measure for external quality assessment in accordance with legal requirements. ConclusionsDue to the nationwide introduction of medication reviews as a pharmaceutical service in June 2022, medication reviews performed by German community pharmacies will gain in importance in the coming years. This is why quality assurance is necessary. Since the participants‘ performance in medication analysis becomes comparable by completing the round robin test, this instrument appears to be potentially suitable for the external quality assessment of medications reviews nationwide.

Investigation of the Group Purchasing Structure in the Field of Pharmaceuticals and Medical Devices: The Case of Public Pharmacies.

The supply chain of pharmaceuticals and medical devices takes on critical importance regarding group purchasing, given its contribution to a country's healthcare system. One of the primary loops in this chain is the pharmacy as a supplier of goods to consumers and a buyer of goods from distributors. Given the importance of proper and productive preparation, this study examined the structure of aggregated procurement of drugs and medical supplies in public pharmacies. This study used a qualitative method and interviews to collect the necessary data. Fourteen experts and specialists in the public pharmacy field were interviewed and selected using the purposive sampling method. Finally, the textual data were analyzed using efficient thematic analysis. According to experts, the organizational structure for aggregated procurement of medicines and medical supplies in Iran's public pharmacies can take the form of a headquarters structure, a virtual structure, and a semi-centralized virtual structure. The main requirements for these structures are software infrastructure, a productive workforce, and improved storage methods. According to the majority of experts, the most desirable structure for implementing aggregated procurement in hospital pharmacies is the headquarters structure. The aggregated procurement process can reduce pharmacy costs and increase financial reserves and profitability if adequately implemented and equipped with the necessary infrastructure.

Pharmacist honoured for COVID-19 vaccination work

A pharmacist has received a British Citizen Award for services to healthcare in recognition of his work in public health pharmacy, in particular during the COVID-19 pandemic. Viral Doshi, who splits his time between community pharmacy and working in public health for Hillingdon Council, was presented with his award on 31 January 2023 in London […]

Abstract A130: Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings

Abstract Introduction: Hospitals and private healthcare facilities are the primary setting for administering the human papillomavirus (HPV) vaccine. A goal of the President's Cancer Panel on HPV vaccination is to maximize access to vaccination services through expansion of alternative settings for receiving the HPV vaccine, such as in public health settings, schools and pharmacies. It is unclear whether utilization of these alternative settings for HPV vaccination is increasing, and which factors are associated with accessing these alternative avenues. Methods: In a cross-sectional analysis, we utilized the National Immunization Survey-Teen data from 2014 to 2020 (n = 59,140) to describe trends and factors associated with HPV vaccine uptake in private, public, and alternative settings. We calculated average annual percent change (AAPC) between 2014 and 2020, estimating the proportion of HPV vaccine across settings. Using multinomial logistic regression, we estimated the odds of receipt of HPV vaccine in public health settings and other alternative settings compared to private healthcare settings, adjusting for sociodemographic covariates. Results: We found a non-significant decrease in proportion of individuals receiving vaccines at public health settings (17.7% in 2014 vs. 13.5% in 2020; AAPC = -3.2), and a non-significant increase in private healthcare settings (79.2% in 2014 vs. 83.9% in 2020; AAPC = 0.6). We also found a non-significant decrease in the proportion of individuals receiving vaccines in alternative settings such as schools and pharmacies (3.1% in 2014 and 2.6% in 2020; AAPC = -0.9). Adjusted multinomial logistic regression analyses found several sociodemographic/socioeconomic factors associated with receiving HPV vaccine at public health facilities versus private/hospital settings. The log odds of receiving vaccinations at a public facility vs. a private facility increases almost four times moving from above poverty (earning≥ $75,000) to below poverty (aOR = 3.74; 95% CI 3.06, 4.57). The log odds of receiving HPV vaccines at a public facility compared to a private facility decreased by 26% for White teenagers vs. Black teenagers (aOR = 0.74; 95% CI 0.64, 0.86), and by 24% (aOR = 0.76; 95% CI 0.58, 0.98) for log odds of receiving vaccine at alternative settings for White teenagers vs. Black teenagers. There was also an association between educational level and log odds of receiving vaccines at a public facility (high school or less vs. college graduate aOR = 0.38; 95% CI 0.31, 0.46), and people without physician recommendations were significantly more likely to receive vaccines at public versus private settings (aOR = 1.71, 95% CI 1.41, 2.08). Conclusions: Sociodemographic and socioeconomic factors such as race, poverty, education, and access to physician HPV recommendations are all associated with receiving the HPV vaccine at public health facilities versus private settings. This information is important in targeting increased vaccine uptake among individuals with less access to care due to these factors. Citation Format: Melissa Christina White, Oyomoare L. Osazuwa-Peters, Dina K. Abouelella, Justin M. Barnes, Eric Adjei Boakye, Trinitia Y. Cannon, Tammara L. Watts, Nosayaba Osazuwa-Peters. Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A130.

EXPERIENCE OF PROFESSIONAL US PHARMACIST TRAINING IN ORGANIZATIONAL AND MANAGEMENT ACTIVITIES IN THE INDUSTRY

The study has analyzed a set of sources of foreign experience in pharmacy specialist training. It has been determined that employees of the pharmaceutical industry must have management and organizational skills to manage personnel and production, the sale of medicinal products in a broad sense of this concept and depending on the specifics of the industry. American scientists pay special attention to the formation of compassion and the ability to maximize patient safety in pharmacists (E. Scott); focus attention on the need for moral education in pharmaceutical educational institutions (D. Latif); develop cultural qualities of pharmaceutical workers as the ability to service-oriented partnership while considering the development of communicative qualities, tact, benevolence towards the customers of the pharmacy as crucial (D. Rodiz). Practicing teachers in the USA supported the position regarding the formation of professional culture and its deontological component in the process of teaching the disciplines «Pharmaceutical law and ethics», «Personal care and elementary medicine», «Pharmaceutical management», etc. It has been found that the existing educational programs of pharmaceutical faculties in the USA are deeply oriented towards mastering organizational and administrative skills by future specialists; it enables rapid retraining and response to dynamic changes in market conditions. Emphasis is placed on the need for additional graduate education preceded by formal degree programs for American pharmaceutical managers.
 It has been established that in the curriculum of pharmacy specialists in the USA, there are the following disciplines: pharmaceutical management, ethics of pharmaceutical activity, interpersonal communications of healthcare professionals, pharmaceutical legislation, and economics. While mastering the specialty of professional practical management (Professional Practice Management), pharmacy specialists study financial management, pharmacoeconomics, cost containment strategies, labor resource management, and the choice of specialization in one of the directions of pharmaceutical management (public pharmacy, entrepreneurship, drug production research, pharmaceutical supply management). It gives reason to conclude attention to the formation of the pharmacists' organizational and management culture. From the perspective of research activity on the issue, the specification of the theoretical foundations and detailing methodological aspects of the American experience implementation of training specialists are outlined.

Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings.

Despite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs). All public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017-2019 to assess pricing and availability of medications for the management of asthma and COPD. We surveyed all 63 pharmacies in respective study areas in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private). The availability of any medication for respiratory disease was higher in private (93.3%) compared to public (73.3%) pharmacies. Salbutamol (WHO-EML) monotherapy in any formulation was the most commonly available respiratory medication among the three sites (93.7% Nepal, 86.5% Peru and 79.2% Uganda) while beclomethasone (WHO-EML) was only available in Peru (33.7%) and Nepal (22%). LABA-LAMA combination therapy was only available in Nepal (14.3% of pharmacies surveyed). The monthly treatment cost of respiratory medications was lowest in Nepal according to several cost metrics: the overall monthly cost, the median price ratio comparing medication costs to international reference prices at time of survey in dollars, and in terms of days' wages of the lowest-paid government worker. For the treatment of intermittent asthma, defined as 100 mcg Salbutamol/Albuterol inhaler, days' wages ranged from 0.47 days in Nepal and Peru to 3.33 days in Uganda. The availability and pricing of respiratory medications varied across LMIC settings, with medications for acute care of respiratory diseases being more widely available than those for long-term management.

Location, location, location: does providing public health services from community pharmacies contribute to tackling health inequalities?

Community pharmacies have long been advocated as an accessible source of advice on health improvement in communities. This cross-sectional study explored the association between provision of pharmacy public health services and factors that might influence the extent to which pharmacies contribute to tackling inequalities. Publically available data were used to explore the association between pharmacy public health service provision and pharmacy characteristics (socioeconomic deprivation, urbanity, opening hours and workload). Regression models were fitted to the number of service consultations. The association between the number of services provided and the mean number of consultations across each service was investigated using regression models. Pharmacies showed a propensity for being situated in areas of higher socioeconomic deprivation. There was no association between socioeconomic deprivation and number of service consultations a pharmacy provided. Clustering of pharmacies in less affluent areas led to over half of all public health service consultations being in the two most deprived quintiles. Providing healthcare services from pharmacies in more deprived areas does not mean the public use them or that pharmacies will prioritize their delivery. The higher prevalence of pharmacies in disadvantaged communities is an important factor in ensuring pharmacy services support reducing inequalities.

Price, Availability and Affordability of Anti-Cancer Medicines in Addis Ababa, Ethiopia.

Cytotoxic drugs are essential treatments available for patients with cancer. There are concerns that unavailability and high prices of cancer medicines may limit patient access. Since information on availability, prices and affordability for cancer medicine is lacking for several countries, particularly for lower income countries like Ethiopia, it will be difficult to know the real situation of those medications' access. The purpose of this study was to assess availability, affordability and price of anti-cancer medications, in Addis Ababa, Ethiopia. The study was cross-sectional using a modified form of the WHO/HAI methodology of measuring medicine price, availability and affordability in public, private, Kenema municipal and Red Cross Pharmacies found in Addis Ababa, Ethiopia. Data on the availability and price of 47 cytotoxic medications for both lowest priced generics and originator brands were collected in 3 public, 6 private and 2 NGO pharmacies which are expected to dispense cytotoxic medications in Addis Ababa. The data were entered and analyzed using WHO/HAI data entry and analysis form. Results were presented in tables and figures. The majority of the anti-cancer medications assessed were not available and the few available medicines were unaffordable. The lowest priced generic were relatively more available (34.8%) than the originator brand medications (2.8%) in the public sector. Generally, the availability of anti-cancer medicine differs when comparing the public, private and other sectors. The availability of cytotoxic medications was 18.8%, 5.3% and 8.8% in the public, private and other sectors. The prices of cytotoxic medications available in the private sector were higher than the public and other sectors. All of the medications except for anastrazole were unaffordable. Medicines for cancer treatment are unavailable and the few available medicines are unaffordable in Addis Ababa, Ethiopia. Different interventions should be done to improve access to cytotoxic medications.

The Present Policy of the National Health Care System in Sudan

The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this study. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low-quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.

Availability and affordability of cardiovascular medicines in a major city of Afghanistan in 2020.

Affordable access to quality medicines is a critical target of global efforts to achieve universal health coverage. The aim of this study is to measure the affordability and accessibility of cardiovascular medicines in the city of Herat, Afghanistan. The price, affordability, and availability data for 18 most sold generic (MSG) and lowest priced generic (LPG) products were collected from public and private pharmacies located in Herat city in Afghanistan in 2020, which in each area, six pharmacies were randomly selected from a combination of public and private ones based on the standardized methodology developed by WHO/HAI. According to this methodology on Medicine Prices, Accessibility, and Affordability, the minimum daily wage of an unskilled governmental worker, and the price of each type of cardiovascular medicines for one-month use were calculated separately. If the cost of the treatment was more than the minimum daily wage, the medicine was considered unaffordable. The mean availability score for lowest price generic (LPG) in public and private pharmacies and based on the countries of origin including Iran, Pakistan, and India was 60%, 46%, and 31%, respectively. Of the 18 medicines surveyed, just Atenolol (Iranian brand) was found in all 30 pharmacies on the day of data collection. All Indian- brand medicines were less than fifty percent available in any of the surveyed public and private pharmacies. Among the medicines exported to Afghanistan, the population of Herat used more medicines made by Pakistan compared to India and Iran (MSG). Indian medicines were the most expensive ones and the Iranian medicines were the cheapest. A wage of less than one day was enough to afford one-month supply of generic medicines at the lowest price. Access of patients to cardiovascular medicines in Afghanistan was 46% in this study which is regarded as low access. Most of available cardiovascular medicines in the market of this country were made in Iran, Pakistan and India. Although the Iranian ones were the cheapest, but people used more Pakistani medicines. LPG products were affordable to the studied population.