Rational Use Of Medicines Research Articles

Influence of Zhuanggu Guanjie Pill on Seven Cytochrome P450 Enzymes Based on Probe Cocktail and Pharmacokinetics Approaches.

The use of herbal medicines has tremendously increased over the past few decades. Case reports and controlled clinical investigations of herbal-drug interactions have been reported. Since Cytochrome P450 (CYP) enzymes play an important role in drug interactions. The evaluation of the influence of herbal medicines on the activities of CYPs is beneficial to promote scientific and rational clinical use of herbal medicines. Herein, we aimed to develop and validate a method to simultaneously quantify seven CYP cocktail probe drugs consisting of phenacetin (PNC), bupropion (BPP), losartan potassium (LK), omeprazole (OMP), dextromethorphan (DM), chlorzoxazone (CZZ) and midazolam (MDZ) and their respective metabolites in a single acquisition run and use this method to evaluate the influence of Zhuanggu Guanjie Pill (ZGGJP) on seven CYPs. A cost-effective and simple UHPLC-(±)ESI-MS/MS method for simultaneous determination of seven probe drugs and metabolites in rat plasma was developed and validated. Male and female rats were randomly divided into three groups and treated with 1.2 g/kg/d ZGGJP, 5 g/kg/d ZGGJP and 0.5% CMC-Na for 14 consecutive days. After 24 h of the last administration, all rats were administrated orally with probe drugs. The influence of ZGGJP on the CYPs was carried out by comparing the metabolic ratio (Cmax, AUC0-t) of metabolites/probe drugs in rats. The calibration curves were linear, with correlation coefficient > 0.99 for seven probe drugs and their corresponding metabolites. Intra- and inter-day precisions were not greater than 15% RSD and the accuracies were within ± 15% of nominal concentrations. The ZGGJP showed significant inductive effect on CYP1A2, CYP2B6, CYP2C9 and CYP3A in male and female rats. ZGGJP had inductive effects on CYP1A2, CYP2B6, CYP2C9 and CYP3A in male and female rats.

Development strategy and current situation of Chinese patent medicine for children in China

This study took the 2020 edition of Chinese Pharmacopoeia(ChP) and the 2018 edition of National Essential Drug List(NEDL) for children as research carriers to systematically analyze the current situation of and problems in the use of Chinese patent medicine for children(CPMC) in China. In view of the problems of imprecise dosage, incomplete safety information, and lack of sui-table varieties, dosage form and specification of CPMC in China, development strategy of CPMC in the future was proposed. It is reco-mmended to carry out systematic post-marketing revaluation studies of CPMC, encourage the development of new varieties or new dosa-ge forms suitable for children, advocate the continuous promotion of real-world studies on children, and expand the information on the use of CPMC with real-world data, so as to lay the foundation for post-marketing revaluation of CPMC and guide the rational use of clini-cal medicines. This study was expected to build a positive policy ecosystem to ensure the supply of CPMC, and promote the high-quality development of CPMC.

Drug utilization in patients with SARS-CoV-2 in an intensive care unit

Context: Prescription indication studies allow identifying the problems that arise during the use of the drug. Aims: To evaluate the treatments used in patients diagnosed with SARS-CoV-2 infection hospitalized in critical care service, through a prescription indication study. Methods: A longitudinal observational study of medication use of the indication-prescription type with elements of the therapeutic scheme and practical consequences was carried out. The sample was characterized from the sociodemographic, clinical, and pharmacotherapeutic points of view. The prescription was evaluated through the indicators: indication, therapeutic scheme, treatment individualization, and drug combinations. The detected adverse reactions were classified according to their causality by the Naranjo Algorithm, their severity, their clinical significance, and according to their mechanism by Rawlins and Thompson. Results: In the sample (n = 77), the male gender predominated (79%) between 27-59 years old (64%), alcohol consumer (62%), hypertensive (33%) with long hospital stay (51%). A total of 417 medications were analyzed, being antibiotics (50.6%) the most prescribed. 73.4% of the therapeutic schemes were correct; however, 26.6% had problems with the therapeutic schemes due to incorrect doses, intervals, duration of treatment, and risky interactions. According to Rawlins and Thompson, two probable adverse reactions were detected, mild, non-serious, and type A and B. Conclusions: The results obtained will allow the pharmaceutical professional to create risk matrices that guarantee a timely intervention in the health team to contribute to the rational and safe use of medicines in patients infected with SARS-CoV-2.

Assessment of WHO core drug use indicators at a tertiary care Institute of National importance in India.

Rational prescribing of medicines is an important aspect of drug prescribing which helps in safe and efficacious and cost-effective drug treatment for patients. WHO Prescription indicators are intended to evaluate the services provided to the population concerning the rational use of medicines. The study aims to study prescription practices and rational use of medicines in the department of Internal medicine, using WHO prescribing indicators in a tertiary care teaching institute of national importance. A total of 50 prescriptions were digitally photographed and analysed for prescription practices and rational drug use, using standard WHO core prescribing indicators. A total of 301 drugs with multiple and diverse diagnoses were used. Statistical analysis was done using SPSS 22 version. The average number of drugs per prescription was 3.48%. It was found that only 13.79% of prescriptions have generic names, whereas 27.58% of patient encounters had at least one drug from the National List of Essential Medicine, 6.8% of prescriptions have antibiotics and 0.7% of prescriptions were injections. The number of prescriptions with fixed drug combinations was 27.55%. Indicators such as percentage of the National List of Essential Medicine, fixed drug combinations and prescribing with a generic name are used. Hence, we will suggest regular prescription audit practices and conducting CMEs and training workshops for clinicians for the rational use of medicines in all healthcare settings to succeed in the rational use of medicine.

Usage and Storage Patterns for PCM Oral Suspension during Consumption among Mothers in Aden City

In most families, medicines are stored for various reasons, including treating chronic or severe ailments. Therapeutic effectiveness of medicines can be affected by prolonged storage. This study evaluated the in-home usage and storage of paracetamol (PCM) oral suspension during consumption among Aden city mothers. A cross-sectional study was conducted during four months (January to April 2019) using the distributed questionnaire. Mothers who had no children were excluded. The survey included 430 mothers. About 305 (70.9%) mothers stored PCM suspension in the refrigerator, and 260 (60.5%) kept it in the outer carton. Nearly 194 (45.1%) mothers store liquid PCM until it expires, while 23.7% regard the physical features of medicine. Over 208 (65.1%) mothers used the manufacturer’s tools to withdraw the doses, however, 33 (7.7%) said syringes are easier to use. The study also found that although 242 (56.3%) users received medicine from a physician, 194 (45.1%) mothers did not get instructions on how to receive it from the practitioner. Only 97 mothers (22.6%) used PCM as an antipyretic and analgesic. Mothers are key persons in a household. However, they lack the knowledge of a common medicine used at home, such as PCM. Yemeni mothers’ knowledge and practice about the usage and storage of PCM suspensions were concerned. Public education and awareness programs are important for enhancing the rational use of medicines.

ACCESS TO MEDICINE

Availability and access to the health care facility is a fundamental right of human, it is the timely used of services according to the needs. It is included in International treaties and is recognized by authorities and various Governments throughout the world. What does it means the access to medicine? According to WHO (World Health Organization) access to medicines is “having medicines continuously available and affordable at public or private health facilities or medicine outlets that are within one hour’s walk from the homes of the population”. The affordability and availability of medicines is directly related to the strength of health care system, but the high prices of the medicines, prevalence of Non-communicable diseases (diabetes, hypertension) and increasing demand of patients are the major obstacles in this regard. According to Forbes “at least 2 billion people don’t have access to medicines and 1 billion people live in extreme poverty (less than $1.25 per day) and 2.2 billion live on less than $2 per day which is quite disturbing situation”. The World Health Organization (WHO) analyzed the global production of pharmaceutical products and it was concluded that 15% of the world’s population consumes over 90% of them. And by World Health Organization it is also estimated that one-third of the developing world population is unable to receive or purchase essential medicine on a regular basis, especially those which are on high demand. The situation is even worst in the under-privileged countries like Africa and Asia, where approximately 50% of the total population does not have sufficient medicines access and healthcare resources and the remaining 50% are using medication incorrectly. However about 10 million lives a year could be saved out of which 4 million in Africa and South-East Asia alone, if we improve the availability, balanced distribution and rational use of medicines. The overall situation of global access to essential medicines is still considered critical. In the privileged countries the budget for healthcare facilities corresponds to 24-66% of National health expenses, which indicates that there is need to monitor the availability and affordability of medicines in these countries. National policies, economical cost of medicine and strategies of procurement are required to ensure the availability of medicines cost-effectively. The people with low income and in-equal health can’t afford costly services of healthcare system. The policies for the improvement of infrastructure, financing of medical system and the rational use of medicines are formulated and followed on primarily basis. And Governments need reliable information in order to evaluate the impact of policy implementation. In addition to the cost and availability of medicines, it is mandatory to assess the quality of use and various aspects, such as rational medicine use, adherence of patients and appropriate prescription practices. Thus the access to healthcare system can be made effective, by the assessment of practices in facilities like record reviews and National expert reports. That’s why we are providing healthcare facilities to each person with the help of balanced geographical distribution. The 2016 Index showed that there is moderate progress by the pharmaceutical industries to improve medicines access. Besides these Pharmaceutical industries should play their role to perk up the medicines access. There is not any particular strategy that suits all systems, but all systems need to promote the provision of new medicinal products, by ensuring medical advancement, improving communication barriers and affordable treatment. And a Reliable Health and Supply system must provide all aspects of health system like procurement, supply and regulation of the medicines.

Promoting a healthy and smart living community in rational use of medicine at RW 05 Kebun Jeruk, West Jakarta

Omicron is a large family of corona viruses that can cause illness ranging from mild to severe symptoms. This severe symptom of Covid-19 will be worrying if it afflicts erderly and toddlers. Lack of knowledge about proper medication use, health precautions, and the importance of handwashing are some of the issues that exist in the community of RW 05 Kebon Jeruk. Based on the survey, it is necessary to carry out community service which aims to determine public knowledge in responding to the Covid-19 pandemic. In addition, it also monitors public knowledge about the rational use of drugs and children's knowledge about the importance of keep healthy. The methods used in this program are door-to-door counseling and education, question and answer and discussion, coloring competition and socialization of little pharmacists, posyandu, morning exercise, delivery of family medicinal plants, and distribution of new normal kit packages. According to questionnaires, education, and other activities, the public's understanding of rational medicine, children's understanding of the importance of keep healthy, and the public's understanding of how to respond to the pandemic period have all increased.

Adherence to Prescribing Indicators at a District Hospital in Ghana: Do We Match WHO Standards?

(1) Background: Rational use of medicines (RUM) and their assessment are important to ensure optimal use of resources and patient care in hospitals. These assessments are essential to identifying practice gaps for quality improvement. (2) Methods: Assessment of adherence to WHO/International Network for Rational Use of Drugs core prescribing indicators among outpatients in 2021 was conducted at the University Hospital of the Kwame Nkrumah University of Science and Technology in the Ashanti Region of Ghana. We reviewed electronic medical records (EMR) of 110,280 patient encounters in the year which resulted in 336,087 medicines prescribed. (3) Results: The average number of medicines prescribed per encounter was three, with generics being prescribed in 76% of prescriptions. Injections were prescribed in 7% of encounters while 90% of medicines were from Ghana’s Essential Medicines List, 2017. (4) Conclusions: With the exception of patient encounters with injections, none of the prescribing indicators assessed in this study met WHO optimum levels, providing targets for quality improvement in RUM. Implementing prescribing guides and policies, regular audits and feedback as well as continuous professional development training may help to improve prescribing practices in the hospital.

Advances in mass spectrometry imaging for toxicological analysis and safety evaluation of pharmaceuticals.

Safety issues caused by pharmaceuticals have frequently occurred worldwide, posing a tremendous threat to human health. As an essential part of drug development, the toxicological analysis and safety evaluation is of great significance. In addition, the risk of pharmaceuticals accumulation in the environment and the monitoring of the toxicity from natural medicines have also received ongoing concerns. Due to a lack of spatial distribution information provided by common analytical methods, analyses that provide spatial dimensions could serve as complementary safety evaluation methods for better prediction and evaluation of drug toxicity. With advances in technical solutions and software algorithms, mass spectrometry imaging (MSI) has received increasing attention as a popular analytical tool that enables the simultaneous implementation of qualitative, quantitative, and localization without complex sample pretreatment and labeling steps. In recent years, MSI has become more attractive, powerful, and sensitive and has been applied in several scientific fields that can meet the safety assessment requirements. This review aims to cover a detailed summary of the various MSI technologies utilized in the biomedical and pharmaceutical area, including technical principles, advantages, current status, and future trends. Representative applications and developments in the safety-related issues of different pharmaceuticals and natural medicines are also described to provide a reference for pharmaceutical research, improve rational clinical medicine use, and ensure public safety.

Affecting children's knowledge about rational use of medicines using read-along videos of pictorial storybooks.

Although efforts have been taken to educate the public about medication from a very young age, there are very limited availability and accessibility of education material for children. The aim of this study is to assess the impact of read-along videos of pictorial storybooks on children’s knowledge about rational use of medicines. This study compared pre and post knowledge scores in a nonrandomized, one-group pre-test-post-test experimental design. Pre-recorded read-along storytelling videos were used as intervention covering two topics on rational use of medicine -medicine storage and antibiotic resistance. The questionnaire and intervention videos were distributed using Google Forms to children aged six and seven in Malaysia via online social media platforms. 521 children completed the study. The mean baseline knowledge score for medication storage was 4.89 (SD = 1.12) pre-test and 5.44 (SD = 0.78) post-test while for antibiotic resistance the mean was 3.616 (SD = 1.340) pre-test and 4.820 (SD = 1.134) post-test. A Wilcoxon signed-rank test showed statistically significant changes on medication storage (Z = −10.21, p < 0.001) and antibiotic resistance (Z = −14.869, p < 0.001) related knowledge among children. Pictorial storybook read-along video interventions were shown to be effective in improving children’s knowledge on rational use of medicine. Education and awareness on the use of antibiotics should be prioritized.

Switching Among Biosimilars: A Review of Clinical Evidence.

Biological medicines have improved patients’ outcomes, but their high costs may limit access. Biosimilars, alternatives that have demonstrated high similarity in terms of quality, safety, and efficacy to an already licensed originator biological product, could increase competition and decrease prices. Given the expanding number of biosimilars, patients may switch from originator to biosimilar or among biosimilars. Randomized trials and observational studies conducted with multiple biosimilars over many disease areas confirmed the safety and efficacy of switching from originator to biosimilar. This study summarizes evidence on switching between biosimilars for which there are concerns to provide future guidance. A systematic search (MEDLINE, Embase, and Cochrane Library) for studies on anti-TNF agents, assessing clinical efficacy and safety of biosimilar-to-biosimilar switch in chronic inflammatory diseases, was performed. We retrieved 320 records and included 19 clinical studies. One study with historical control compared switching between biosimilars to maintenance of the same biosimilar. Ten were controlled cohort studies comparing switching between two biosimilars vs. switching from originator to a biosimilar or vs. multiple switches. Eight were single-arm cohort studies, where participants switched from one biosimilar to another, and the outcomes were compared before and after the switch. Overall, these studies did not highlight significant concerns in switching between biosimilars. Therefore, switching studies seem difficult to perform and unnecessary with the body of evidence suggesting no real problems in practice coupled with stringent regulatory requirements. Monitoring the use of biosimilars in clinical practice could support clinical decision-making, rational use of biological medicines, and help to further realize possible savings.

Effect of Traditional Chinese Medicine Pharmacists Intervention in General Internal Medicine to Develop Rational Use of Traditional Chinese Medicine

Effect of Traditional Chinese Medicine Pharmacists Intervention in General Internal Medicine to Develop Rational Use of Traditional Chinese Medicine

Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators.

Rational use of medicine (RUM) for all medical conditions is crucial in attaining quality of healthcare and medical care for patients and the community as a whole. However, the actual medicine use pattern is not consistent with that of the World Health Organization (WHO) guideline and is often irrational in many healthcare setting, particularly in developing countries. Thus, the aim of the study was to evaluate rational medicine use based on WHO/International Network of Rational Use of Drugs (INRUD) core drug use indicators in Eritrean National and Regional Referral hospitals. A descriptive and cross-sectional approach was used to conduct the study. A sample of 4800 (600 from each hospital) outpatient prescriptions from all disciplines were systematically reviewed to assess the prescribing indicators. A total of 1600 (200 from each hospital) randomly selected patients were observed for patient indicators and all pharmacy personnel were interviewed to obtain the required information for facility-specific indicators. Data were collected using retrospective and prospective structured observational checklist between September and January, 2018. Descriptive statistics, Welch's robust test of means and Duncan's post hoc test were performed using IBM SPSS (version 22). The average number of medicines per prescription was 1.78 (SD = 0.79). Prescriptions that contained antibiotic and injectable were 54.50% and 6.60%, respectively. Besides, the percentage of medicines prescribed by generic name and from an essential medicine list (EML) was 98.86% and 94.73%, respectively. The overall average consultation and dispensing time were 5.46 minutes (SD = 3.86) and 36.49 seconds (SD = 46.83), respectively. Moreover, 87.32% of the prescribed medicines were actually dispensed. Only 68.24% of prescriptions were adequately labelled and 78.85% patients knew about the dosage of the medicine(s) in their prescriptions. More than half (66.7%) of the key medicines were available in stock. All the hospitals used the national medicine list but none of them had their own medicine list or guideline. In conclusion, majority of WHO stated core drug use indicators were not fulfilled by the eight hospitals. The results of this study suggest that a mix of policies needs to be implemented to make medicines more accessible and used in a more rational way.

KNOWLEDGE OF RATIONAL USE OF MEDICINE AMONG NURSING STUDENTS

Introduction: Rational use of medicine (RUM) is critical for achieving therapeutic goals and avoiding unwanted effects. However, irrational medicine use is becoming a severe issue worldwide since it leads to increased medical costs and unwanted effects. Students as prospective professional nurses need to have knowledge that supports the rational use of medicine to ensure rational administration of the medicine for patients. Methods: This descriptive research was conducted to identify knowledge of rational use of medicine among nursing students of Faculty of Nursing Universitas Padjadjaran. Quantitative data was collected by asking respondents to fill out questionnaires. A total of 285 respondents had filled out an online research questionnaire (response rate=76.61%). The collected data were analyzed with descriptive analysis (frequency, percentage, and average). Result: The results of this study showed that there is some knowledge related to (RUM) which is not appropriate, such as assuming that over the counter medicines are safe to consume with prescribed medicines (53.3%); tablet medicines can be divided to be administered in child patients (57.9%). In addition, almost all respondents considered it unnecessary to be cautious in giving medication to pregnant and lactating mothers (41.1%) and the elderly (40.4%). Conclusion: Thus, nursing students are expected to gain RUM knowledge to obtain better RUM attitudes and behaviors in providing nursing interventions.

FORMATION OF PROFESSIONAL COMPETENCIES OF FUTURE PHARMACISTS IN IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY

The development of socio-economic transformations in Ukraine requires and makes new demands on the process of training specialists in the pharmaceutical industry. The profession of pharmacist is socially important and has its own characteristics because it is aimed at maintaining and improving human health, prevention and prophylaxis of diseases.&#x0D; The purpose of this work is to analyze the formation of the process of professional competency of the future pharmacist in classes on pharmaceutical disciplines at Ivano-Frankivsk National Medical University.&#x0D; The object of this research was the professional training of future pharmacists at Ivano-Frankivsk National Medical University. To achieve this goal we have used such methods of scientific analysis as generalization, comparison, systematic and logical analysis.&#x0D; A qualified pharmacist is a healthcare professional who is responsible for the rational use of medicines and makes every effort to provide patients with effective medicines and high-quality pharmaceutical services.&#x0D; The concept of professional training declares that the structure, content and quality of pharmaceutical education must meet national and international standards. The analysis of the qualification characteristics of the professions in the field of health care shows that for the successful training of a competitive specialist it is necessary to select a number of general and special competencies and to form the relevant program results for higher education seekers.&#x0D; The World Health Organization has proposed the Seven-Star Pharmacist concept, according to which the pharmacist must have special knowledge and skills, be responsible in the performance of his professional duties, carefully and dignifiedly treat the patient, because it is about the personal needs of a person who is waiting for professional help. To implement this concept the pharmacist must have a number of competencies provided by the educational and professional program “Pharmacy, Industrial Pharmacy” in the field of knowledge 22 “Health Care”, in specialty 226 “Pharmacy, Industrial Pharmacy” of the second (master’s) level. This program focuses on the current requirements of the World Health Organization for the role and mission of the pharmacist in the health care system. It organically combines theoretical and practical components of training on the bases of practice in conditions as close as possible to real. The program is implemented in a logical sequence of disciplines of the curriculum. A number of program competencies, which must be possessed by a pharmacy student, are characterized within the educational and professional program.&#x0D; Thus, in the formation of the personality of a pharmacy student, who is future master in the field of pharmacy, an important role is given to the professional orientation of education in Ivano-Frankivsk National Medical University, which is not possible without the high-quality theoretical and practical training in basic sciences.&#x0D; The formation of professional competency of future pharmacists takes place in lectures, practical and seminar classes in pharmaceutical disciplines, as well as during training and manufacturing practice in accordance with the curriculum. Their main task is to provide the higher education students with the competencies specified in the standard of higher pharmaceutical education.

Drug Management in Households of Bamako, Mali

The rational use of medicines is a concern of any health policy in many countries. The aim of this study was to investigate the management of medicines in households in Bamako, Mali. It is a descriptive cross-sectional study, which took place from August to October 2020. Random sampling was used. A questionnaire was used to collect data on socio-demographic characteristics and family drug management. Data were entered and analyzed on Epi info version 17 software. Informed and verbal consent was obtained from the respondents. Of the 150 households visited, 99% had medicines at the time of the survey. For the storage of medicines, 2.7% of respondents used a medicine cabinet. Among the medicines found in the households, painkillers were the most represented (184/668). More than 52% of the medicines in households were acquired on medical prescription against 48% on self-medication. And 21.3% declared that the medicines were within the reach of children. We found that all the households surveyed had a stock of medicines and the bedroom was the room most often used to store them. Very few had a cupboard dedicated to storing medicines in the family.

Assessment of rational use of medicines for chronic non-communicable diseases: A cross-sectional design in a public access clinic in Jamaica.

Background:Rational use of medicines (RUM) offers a cost-saving strategy to maximize therapeutic outcomes. The aims of this study were to assess RUM for chronic non-communicable diseases (NCDs) using the World Health Organization’s (WHO) prescribing indicators in a public access facility and to evaluate the alignment of the use of drugs with therapeutic recommendations/guidelines.Design and methods:In this retrospective cross-sectional study, prescriptions of adult patients containing at least one drug for chronic NCDs, filled between January and July 2019 were reviewed using the WHO prescribing indicators for RUM. Data were analyzed and expressed as descriptive statistics. Associations were determined using chi-square tests, correlations using Pearson’s correlation and medians compared using Mann-Whitney U test. For all analyses, significance was determined at p < 0.05.Results:Of the 571 prescriptions reviewed, most were for female, elderly patients with mean age of 69 years, predominantly with hypertension and/or diabetes. Polypharmacy was noted for 53.6% of prescriptions, primarily in elderly patients (p < 0.001), with the median number of five drugs prescribed and three dispensed. Of the drugs prescribed, 76.6% used generic prescribing, 63.3% were dispensed as written and 3.9% were antibiotics prescribed mainly for asthmatic patients (χ2 = 74.9, p < 0.001). Drugs prescribed for NCDs were aligned to therapeutic guidelines, but a significantly higher proportion of diabetes medications, (metformin and gliclazide), and cardiovascular medications (enalapril and losartan), were not dispensed as written (χ2 = 40.0, p = 0.007).Conclusion:This research indicates that there is positive alignment with recommended therapeutic guidelines, however, based on WHO prescribing factors, strategies to improve RUM in this setting are highly recommended.

Pharmacovigilance in emerging economies: modeling interaction among barriers

PurposeThe main purpose of this paper is to identify and rank various barriers to pharmacovigilance (PV) in context of emerging economies and examine their interrelationships using the interpretive structural modeling (ISM) approach. The result is a model that offers insights about how to achieve rational and safe use of medicines and ensure patient safety as realized through robust national PV systems.Design/methodology/approachThe paper develops a model to analyze the interactions among PV barriers using the ISM approach. Based on input from clinical and medical product development experts, PV barriers in emerging economies were identified and reviewed. The hierarchical interrelationships among these PV barriers were analyzed in context of their driving/dependence powers.FindingsFindings of the study identify key PV barriers—lack of resources/infrastructure, weak legislation, unfair burden of disease, lack of PV capacity, training, and enforcement authority—that drive, or strongly influence, other barriers and thwart implementation of robust national PV systems in emerging economies. Pharmaceutical industry factors were PV barriers that were identified as autonomous, implying their relative disconnection from other barriers, and patient PV practices barrier was strongly dependent on other barriers.Research limitations/implicationsThe paper offers policy- and decision-makers alike with a framework to support further research into interdependencies among key PV barriers in emerging economies. It can serve as an impetus for further research with potential to broadening the understanding of how and why PV systems may be rendered ineffective. Future studies can be planned to apply the ISM approach to study PV barriers in the context of developed economies and draw lessons and implications for policy- and decision-makers by contrasting results from these studies.Practical implicationsThis paper contributes to the understanding of the multifaceted nature of PV and its barriers. The proposed approach gives public health decision-makers a better comprehension of driver PV barriers that have most influence on others versus dependent PV barriers, which are most influenced by others. Also, knowledge, attitude and practices of patients and caregivers can also be critical PV barriers in emerging economies. This information can be instrumental for public health policymakers, government entities, and health/PV practitioners to identify the PV barriers that they should prioritize for improvement and how to manage trade-offs between these barriers.Social implicationsPV barriers in emerging economies, as compared to developed economies, are inherently different and need to be examined in their specific context. The hierarchical ISM model suggests that resources and regulation initiatives by governments in emerging economies lead to through informed/enabled pharmaceutical supply chain players and eventually drive PV-specific knowledge, attitude, and practice outcomes improvements across their populace.Originality/valueThis paper highlights the deployment of ISM approach as a health policy decision support tool in the identifying and ranking barriers to effective PV systems in emerging economies, in terms of their contextual relationships, to achieve a better understanding as to how these interrelationships can affect national PV system outcomes.

A description of sodium valproate, lamotrigine and levetiracetam consumption in the Western Cape public sector.

BackgroundThe rational use of medicine is fundamental to ensure effective and safe patient medicine treatment, and hence, should be monitored. Undisputable evidence exists for the teratogenic risk factors associated with sodium valproate. Consequently, the Western Cape Department of Health introduced a policy (2019) recommending alternatives for valproate in women of childbearing age, including lamotrigine or levetiracetam as alternatives for patients on antiretrovirals. This study aimed to describe the change in the consumption of valproate, lamotrigine and levetiracetam after a policy implementation in public sector health facilities of the Western Cape, South Africa.MethodsThis observational study followed a quasi-experimental design. Consumption data from the Cape Medical Depot over the period 01 April 2018 to 31 March 2020 were analysed retrospectively. Consumption was presented as a defined daily dose (DDD) per 1000 population per quarter for sodium valproate, levetiracetam and lamotrigine for the Western Cape province, urban and rural areas. Consumption 12 months before was compared with consumption 12 months after policy implementation.ResultsPost-policy implementation, valproate consumption remained unchanged provincially (3.3%; p = 0.255), in urban (7.8%; p = 0.255) and rural (1.5%; p = 0.701) areas. Lamotrigine consumption increased significantly provincially (30.7%; p = 0.020) and in urban areas (54.5%; p = 0.002); however, rural (26.1%; p = 0.108) areas did not show significant change. Provincially, valproate consumption remained substantially higher (209 DDDs/1000 population per quarter) compared with lamotrigine consumption (32.22 DDDs/1000 population per quarter).ConclusionIn the Western Cape public sector, the consumption of sodium valproate remained unchanged 12 months after policy implementation. Although there were significant increases in lamotrigine and levetiracetam consumption, the consumption was considerably less compared with sodium valproate consumption.

Evaluation of the legal aspects of prescriptions of drugs subject to prescription retention in a communitarian dispensing pharmacy in Joinville / Avaliação dos aspectos legais da prescrição de medicamentos sujeitos a retenção de receita numa farmácia comunitária de distribuição em Joinville

The prescription is the legal document that defines the patient’s drug therapy, thus it must be intelligible and readable to allow the dispensation of the correct drugs to the patient in the right dose, route of administration and quantity. Incomplete and illegible prescriptions lead to misunderstanding and consequently, medication errors, which may cause from ineffectiveness to serious adverse reactions. Hence, this study aimed to evaluate the legal aspects of drug prescriptions subject to prescription retention in a Basic Health Unit (BHU) of Joinville (Santa Catarina state). For this purpose, the adequacy and legibility of information concerning patients, prescribers, and psychotropic and antimicrobial drugs of the prescriptions dispensed by a BHU from July 15 to August 15, 2018, were analyzed totaling 500 prescriptions, of which 250 were psychotropic and 250 were antimicrobial, about 17% handwritten and 83% typed. No prescriptions mentioned the patients' telephone number and few prescriptions omitted gender and address, especially the handwritten ones. Concerning the prescribers' data, few omissions were observed, related to their contact data. All drugs were prescribed in the Brazilian Common Denomination (BCD), and all psychotropic prescriptions had no omissions of route and quantity, while the handwritten prescriptions of antimicrobials comprised 10-15% omission of these data. Regarding legibility, less than 5% of the prescriptions were partially readable and an even smaller proportion were illegible. Non-standardized abbreviations were observed in 55,6% of the prescriptions. Data allow observing that, although some errors still persist the adoption of typed prescription minimized the problems of legibility, but not the omission of information. The improvement of the prescribing writing applications can also help to minimize omissions and make the prescriptions more comprehensible and ensure adequate guidance on the rational use of medicines.