Medical Sales Research Articles

Methodology to Solve the Combination of the Generalized Assignment Problem and the Vehicle Routing Problem: A Case Study in Drug and Medical Instrument Sales and Service

This article presents algorithms for solving a special case of the vehicle routing problem (VRP). We define our proposed problem of a special VRP case as a combination of two hard problems: the generalized assignment and the vehicle routing problem. The different evolution (DE) algorithm is used to solve the problem. The recombination process of the original DE is modified by adding two more sets of vectors—best vector and random vector—and using two other sets—target vector and trial vector. The linear probability formula is proposed to potentially use one out of the four sets of vectors. This is called the modified DE (MDE) algorithm. Two local searches are integrated into the MDE algorithm: exchange and insert. These procedures create a DE and MDE that use (1) no local search techniques, (2) two local search techniques, (3) only the exchange procedure, and (4) only the insert procedure. This generates four DE algorithms and four MDE algorithms. The proposed methods are tested with 15 tested instances and one case study. The current procedure is compared with all proposed heuristics. The computational result shows that, in the case study, the best DE algorithm (DE-4) has a 1.6% better solution than that of the current practice, whereas the MDE algorithm is 8.2% better. The MDE algorithm that uses the same local search as the DE algorithms generates a maximum 5.814% better solution than that of the DE algorithms.

Short-term effect of outdoor mould spore exposure on prescribed allergy medication sales in Central France.

Outdoor moulds are classically associated with exacerbations of asthma. The aim of this paper was to examine nasal allergy morbidity by studying the short-term relationship between mould spore exposure and daily sales of reimbursable anti-allergic treatment in central France. The relationship between daily changes in mould concentrations and daily sales obtained from the national healthcare database was analysed with generalized additive models, taking into account confounding factors such as air pollution, weather conditions, pollen counts, and days of the week. During the study, the average total yearly number of treated people was around 10000 over approximately 230000 surveyed. The relative risk (95% CI confidence interval) of sales of oral antihistamines with topical treatment associated with an interquartile increase in mould concentration was significant for Cladosporium 1.079 [1.019-1.142] and Aspergillus-Penicillium (Asp-Pen) 1.051 [1.021-1.082] in the whole population. When the influence of age and sex was considered, the relationship was significant only in male children aged 0-12years and those aged between 13 and 49years for Cladosporium: 1.256 [1.081-1.460] and 1.151 [1.063-1.245], respectively. The relationship was also significant for Asp-Pen: 1.038 [1.003-1.075] for those aged between 13 and 49years and 1.056 [1.007-1.108] for adults over 50years of age. The association between prescribed daily sales of oral antihistamines with topical treatment sales is associated with temporal changes to Cladosporium and Aspergillus-Penicillium in the whole population. When the influence of age and sex was considered, these two moulds contributed to prescribed medication sales only in the male general population.

PCN52 - Budget Impact Analysis of Enzalutamide for the Treatment of Metastatic Castration-Resistant Prostate Cancer Patients Progressing after Docetaxel in the Mexican Public Healthcare System

In the Mexican public healthcare (PHC) system, there are few alternatives for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) progressing after treatment with docetaxel. However, healthcare payers are interested in quantifying the budget impact of these therapies. This analysis estimates the budget impact of enzalutamide as an alternative treatment for PHC patients in the Mexican Social Security Institute (IMSS). A model was developed to assess the budget impact of enzalutamide for the treatment of patients with mCRPC after docetaxel progression. Epidemiological data from the National Cancer Institute 2017, Lopez 2016, and Drake 2016 were used to estimate the number of patients in Mexico (i.e. 12 million men aged >40 years). Dosing, administration, duration of therapy, and adverse event rates were based on product labels and published clinical trial results. Drug costs were obtained from local direct medical costs and sales pricing files. Costs of administration and monitoring were obtained from the IMSS website and the published literature. Market shares were estimated for each comparator before and after adoption of enzalutamide. The incremental aggregate budget impact, per patient per year, was calculated. The annual cost of one patient treated with enzalutamide in the Mexican PHC system was estimated at MX$528,862. The epidemiological model predicted that 39 patients would be eligible for treatment with enzalutamide in 1 year, resulting in an overall annual budget impact of MX$20.6 million, which represents a 0.04% impact on the total annual budget for pharmaceutical purchases. Due to the absence of a therapeutic alternative for patients with mCRPC after progression on docetaxel, the introduction of enzalutamide is an affordable option for IMSS in Mexico.

Comparison of phosphodiesterase type V inhibitors use in eight European cities through analysis of urban wastewater

In this work a step forward in investigating the use of prescription drugs, namely erectile dysfunction products, at European level was taken by applying the wastewater-based epidemiology approach. 24-h composite samples of untreated wastewater were collected at the entrance of eight wastewater treatment plants serving the catchment within the cities of Bristol, Brussels, Castellón, Copenhagen, Milan, Oslo, Utrecht and Zurich. A validated analytical procedure with direct injection of filtered aliquots by liquid chromatography-tandem mass spectrometry was applied. The target list included the three active pharmaceutical ingredients (sildenafil, tadalafil and vardenafil) together with (bio)transformation products and other analogues. Only sildenafil and its two human urinary metabolites desmethyl- and desethylsildenafil were detected in the samples with concentrations reaching 60 ng L−1. The concentrations were transformed into normalized measured loads and the estimated actual consumption of sildenafil was back-calculated from these loads. In addition, national prescription data from five countries was gathered in the form of the number of prescribed daily doses and transformed into predicted loads for comparison. This comparison resulted in the evidence of a different spatial trend across Europe. In Utrecht and Brussels, prescription data could only partly explain the total amount found in wastewater; whereas in Bristol, the comparison was in agreement; and in Milan and Oslo a lower amount was found in wastewater than expected from the prescription data. This study illustrates the potential of wastewater-based epidemiology to investigate the use of counterfeit medication and rogue online pharmacy sales.

Pattern of medication selling and self-medication practices: A study from Punjab, Pakistan.

BackgroundAccess to medicines without prescription is a major contributing factor for self-medication practices. This study was designed to examine the ratio of non-prescribed medicines sales and self-medication practices in Punjab, Pakistan. This study also evaluates the reasons for self-medication within its communities.MethodsAn observational study was conducted in 272 systemically selected pharmacies to analyze medicines-related sales, with or without prescription. A cross-sectional survey was performed between June 2015 and November 2016. Consumers were interviewed about their self-medication practices.ResultsOf the pharmacies surveyed, 65.3% participated in the study. A total of 4348 medicines were purchased for self-medication by 3037 consumers (15.2% of all study participants), of which 873 (28.7%) participated in an interview. Majority (81.2%) medicine purchaser, (90.9%) interview participants, and (59.4%) drug users were male. On average, each community pharmacy sold 7.9 medicines without prescription each day, to an average of 5.5 customers. Many participants (28.9%) had matriculation in their formal education. The medicines most often sold for self-medication were analgesics and antipyretics(39.4%). More than 25% of participants reported fever symptoms and 47.8% assumed their illness was too trivial to consult a doctor. Media advertisements were the most common source of information for participants (46.7%).ConclusionMany types of medicines were often sold without prescription from community pharmacies. Self-medication was common practice for a wide range of illnesses. Pakistan also needs effective implementation of policies to monitor medication sales. Public education about rational medication and limits to advertising medicine are very necessary.

Self-medication practices in patients attending a Tertiary Care Teaching Hospital in Urban North-West India

Background: This study was designed to determine the frequency, reasons, and the association of self-medication with demographic and other factors reported by participants. Materials and Methods: This study was conducted in 500 patients visiting a tertiary hospital in Ludhiana, North Western India. Participants were interviewed with a preset questionnaire. Data were entered into Microsoft Excel and analysis was performed using SPSS software version 16. Frequencies and proportions were calculated. Results: Of 500 study participants, 93.8% reported self-medication with no gender difference. The participants who took self-medication were of the opinion that self-medication resulted in quick cure of illness 50.75%, saved their time 17.46%, and gave them a sense of independence in 17.06%, respectively. The common reasons self-medication 45.84% for fever, 18.34% for pain, and 10.87% for headache with nonsteroidal anti-inflammatory drugs 49.4% followed by antibiotics (11.6%) be the common medication. The most common source of information is local chemists/pharmacy 39%. Conclusions: Self-medication is described as a double-edged sword in India, and regulation of over-the-counter sale of antibiotics prescription medication is necessary to safeguard the populace.

195EMF The Use of Non-Physician Prescribed Medication in Cambodia

Because of a lack of resources, many people in developing countries such as Cambodia receive prescription medications from non-physicians, including pharmacists or medication sellers. Studies have shown that non-physician prescribed medications may result in inappropriate dosing/indication, adverse events, and drug/drug interactions. The objectives of this study are to better describe the usage of non-physician prescribed medications in a patient population presenting to two acute care facilities in Phnom Penh, Cambodia and to assess the number of patients who can provide the names of their non-physician-prescribed medications used over the past two weeks. This study is a prospective survey in two Cambodian medical facilities. Research assistants were given training to obtain informed consent and data collection to patients regarding the use of non-physician prescribed medications in the past two weeks prior to presentation. A data collection form was used to collect demographics, medications, including drug names, dose, duration, and where medications were obtained, and if any questions were asked prior to receiving medications, including allergies, medical illnesses, medications, or pregnancy. Patients were asked if they had received any instructions concerning usage and/or adverse effects. This study was approved by the Cambodian and relevant American institutional review boards. Data was summarized using descriptive statistics. Of the 477 patients surveyed, 248 used medications that were not prescribed by a physician prior to the visit. Of these patients, 120 patients could not name their medications nor could staff identify medications they brought. Of the remaining 128 patients, 73 patients brought in all identifiable medications of which at least one was a medication that would require a prescription in the United States, whereas 22 had all identifiable over-the-counter medications. The remaining 33 patients brought in a combination of identifiable and unknown medications. Of the patients using non-doctor prescribed prescription medications, the most common categories were: cardiovascular (70), steroids (54), antibiotics, (34), and anti-diabetic (27) medications. Narcotics/ sedatives (4/15) were infrequently dispensed. A significant proportion of patients in Cambodia use prescription medications that were not prescribed by a licensed physician. Patients lacked awareness of the names of their medications and medications causing adverse reactions. Efforts to regulate the sale of prescription medications should be considered.

글리벡 급여정지를 둘러싼 찬반논쟁에 대한 비판적 고찰*

Glivec (Imatinib) is a medication used in the treatment of chronic myelogenous leukemia. This medication, which is manufactured by Norvatis, was licensed for prescription in South Korea in 2002. After being found guilty of providing illegal rebates to doctors who prescribe Glivec, Norvatis was fined by the Korean Ministry of Health. However, this incident has given rise to a debate concerning how exactly Norvatis should be penalized for its illegal actions. On the one hand, some argue that stiffer punishments should be issued, including a moratorium on the sale of Norvatis medication in Korea. On the other hand, some argue that such actions will unfairly punish leukemia patients rather than targeting the company itself. In this article, we examine the medical, pharmaceutical, and ethical arguments that can be given on both sides of this issue.

Monitoring the 2016 LA County Sand Fire with Multiple Early Detection Systems

ObjectiveTo detect increases in health complaints resulting from the July2016 Sand Fire near Santa Clarita, CA using syndromic surveillanceand complementary systems.IntroductionOn July 22, 2016, the Sand Fire began burning in the Santa ClaritaValley of Los Angeles County (LAC), CA. This urban-adjacentwildfire breached the city limits of Santa Clarita (population 180,000).Fueled by record heat and an ongoing exceptional drought, the SandFire burned over 40,000 acres in 13 days1and caused a large increasein the air concentration of fine particulate matter2. The syndromicsurveillance team was tasked with reporting on possible health effectsfrom the fire. Fire, asthma, and heat related data were monitoreduntil the fire was reported as 98% contained. The team prepared anddistributed a daily special summary report to key stakeholders in theLAC Department of Public Health.MethodsEmergency department (ED) data were queried for cases relatedto fire, asthma, cardiac events, eye irritation, heat, and total volume.These queries consisted of key word searches within chief complaint(CC), diagnosis and triage note data fields. Queries were conductedon all participating syndromic EDs in LAC, and also restricted to nineEDs closest to the fire. The resulting line lists were reviewed dailyto rule out visits that were unrelated to the Sand Fire. The fire querywas refined periodically with additional exclusion terms. Complaintsrelated to asthma were tallied in a second query. In order to assessheat-related ED visits and temperature trends, existing queries andreport templates were modified to focus on the nine fire-area EDs.Local temperatures were taken from the Weather Undergroundwebsite. Complementary systems were also monitored, includingover-the-counter medication sales and nurse hotline call data. Trendgraphs for hospital admissions and ED visits were produced daily toassess volume from 19 Reddinet participating hospitals. In additionto internal data sources, the South Coast Air Quality ManagementDistrict website was checked daily to monitor air quality in the SantaClarita Valley.ResultsThere were 48 syndromic ED patient records with direct mention ofthe fire in LAC’s syndromic hospitals in 13 days. Of these, 26 did notinclude asthma, and 32 came from the nine hospitals in the Sand Fireregion; 32 were identified from the CC, six by diagnosis and ten bytriage note. Despite an increase in fire-related visits, overall trends inED data were not affected; no increase was found for cardiac events,eye irritation, heat-related illness or total volume. Asthma visitsincreased at the time of the fire, which correlates with a sharp increasein the concentration of fine particulate matter in the Santa ClaritaValley following the start of the fire2. However, these increases wereno higher than other peaks observed in previous months3. No increasesin calls to a nurse hotline or over-the-counter medication sales wereobserved. Among Reddinet hospitals, admissions increased slightlybut ED visits remained unchanged.ConclusionsFor the Sand Fire, ED volume alone was not enough to estimatethe subsequent health effects on residents of LAC; instead a specificfire query was needed. Several factors could explain why overalltrends were not affected. In a region where air quality is alreadycompromised, it is challenging to distinguish between asthmaincreases from air pollution from those exacerbated by wildfiresmoke. It is also likely that residents heeded warnings about air qualityduring active fires, thus reducing their outdoor exposure. Althoughthe majority of cases were identified using the CC field, additionaldata fields such as triage notes available from some hospitals improvethe ability to elicit fire related visits. Regardless of the challengespresented in measuring health effects related to wildfires, syndromicsurveillance and complementary systems continue to be the primarytools for near real-time assessments in LAC.

Operating room team member role affects room traffic in orthopaedic surgery: a prospective observational study

Background: Operating room (OR) traffic is an increasing topic of concern for potential risks of surgical site infections (SSIs). We evaluated room traffic rates during orthopaedic surgery cases to better understand how OR team member roles contribute to room traffic. Our hypothesis was that OR traffic differs among team member groups. Methods: We evaluated 46 orthopaedic surgery cases involving implantation of a device at an academic medical center during the summer of 2015. Room traffic rates were recorded as the number of door openings per minute in each case. OR team member groups were defined as follows: Group (A) charge nurse, nurse, scrub technician, scrub technician student; (B) anesthesiology attending physician, anesthesiology resident, anesthesiology medical student, certified nurse anesthetist; (C) orthopaedic surgery attending, orthopaedic surgery resident, orthopaedic surgery medical student; (D) medical sales representative/vendor; (E) radiology technician. Results: The number of door openings ranged from 48 to 259 (mean 127±47). The overall mean room traffic rate per minute per case ranged from 0.2193-1.014 (mean 0.5856±0.1663). Operative length ranged from 90–521 min (mean 226±89.1). There was a statistically significance difference between the median room traffic rate per minute per case by different group (A, B, C, D, and E) types (χ 2 (4) =127.085, P=0.0001). Conclusions: Room traffic rates and number of door openings per case are different among different OR team member groups. Better understanding of room traffic characteristics allows for strategic intervention to decrease room traffic among team members in each group.

Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?

The observation that many people in Africa seek care for febrile illness in the retail sector has led to a number of public health initiatives to try to improve the...

Keeping up with Dental Literature: A Study on Continuing Professional Development among Dental Practitioners in Hubli-Dharwad, India.

Continuing Professional Development (CPD) refers to skills and knowledge attained for both personal development and career advancement. In India, very few studies have been documented to discover the patterns of information update by dental practitioners. To discover the educational tools that dentists of Hubli - Dharwad, Karnataka, India, prefer for updating their knowledge on new therapeutic methods and to assess the perceived usefulness of these CPD activities. Face to face interview was carried out using questionnaire comprising questions on various CPD activities among all the practicing dentists. Pearson's chi-square test was used to evaluate any association between the frequency of information update and perceived usefulness with gender, qualification, practice types and academic attachments. Out of 112 practicing dentists in Hubli-Dharwad, 104 consented for the study. Mean age group of the study population was 32.3±7.56 (SD) years. Discussion with colleagues and discussion with medical sales representatives were the most frequently utilized information sources. On the other hand, attending dental fairs was found to be the most rarely utilized method of information access. Discussion with colleagues, reading textbooks and accessing internet were rated as most useful CPD activities and discussion with sales representatives and attending dental fairs were rated as least useful CPD activities. Both conventional methods of information sources like discussions with colleagues and textbook reading as well as contemporary information sources like accessing internet were the preferred methods of information update by dental practitioners of Hubli-Dharwad.

Patients' perception of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom.

Objective:Patients’ opinion about prevalence of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom. The secondary objective was to identify appropriate action(s) to enhance patients’ awareness of pharmaceutical services in rural areas.Methods:A self-administered, anonymous questionnaire was distributed to patients visiting a community pharmacy in Eye, Suffolk, United Kingdom between July and August, 2015. The main inclusion criterion was living in a rural area. Comparisons were performed using chi-square tests and logistic regression.Results:The study included 103 respondents: 70 women (69.0%) and 33 men (32.0%), aged 16–85 years. Most respondents declared the primary tasks of a community pharmacy were dispensing medicines (86.4% of respondents) and repeat dispensing (72.8% of respondents). Additionally, 23.3% of respondents treated minor ailments at the pharmacy, including bacterial/viral infections, minor injuries, stomach problems, and allergies. The Medicines Use Review service was the only advanced service used in this pharmacy (12.6% of respondents), primarily by men. Younger patients were more familiar with the term of pharmaceutical care (p<0.05; OR=0.33).Conclusions:Only a few pharmaceutical services are utilized by people living in rural areas in the UK, namely prescription dispensing, repeat dispensing, and sale of medications that support self-care for minor ailments. We found an overall poor awareness of the expanded variety of pharmaceutical services encouraged by the community pharmacy contract introduced in the UK in 2005. Therefore, politicians, pharmacists, and pharmacy experts should actively promote these advanced pharmaceutical services in rural areas.

Health-related quality of life and depression among medical sales representatives in Pakistan.

Pharmaceutical companies have been known to pose stress and mental harassment on medical sales representatives (MSRs) in-order to increase pharmaceutical sales. This cross sectional descriptive study, conducted during November and December 2014 in the Lahore and Bahawalpur districts of Punjab, Pakistan, evaluates the Health-Related Quality of Life (HRQoL) and extent of depression among MSRs in Pakistan. The significant predictors of HRQoL and depression among the MSRs were also determined. Using a convenience sampling technique, all consenting MSRs (N = 318) of pharmaceutical companies were asked to self-complete the Short Form-36 (SF-36v2) Health Survey and Stanford Personal Health Questionnaire (PHQ-8). The standard scoring scheme for the SF36v2 and PHQ-8 questionnaires was used. The PHQ-8 scores showed that 16.4 % (n = 52) and 2.5 % of respondents were suffering from major depression and severe major depression, respectively. Being depressed and having difficulty in achieving sales targets were the factors independently associated with lower physical health. Similarly, depression, insufficient time for the family and monthly income less than 36,000 Pakistan Rupees were significant predictors of lower mental health. The factors associated with depression included insufficient time for the family and unsatisfactory behavior of the managers. Compromised mental health and the prevalence of depression among the MSRs suggest pharmaceutical companies need to devise health management strategies and interventions to ensure effective prevention and management of mental health problems among Pakistani MSRs.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2716-1) contains supplementary material, which is available to authorized users.

Respiratory medication sales and urban air pollution in Brussels (2005 to 2011)

BackgroundWe investigated the associations between daily sales of respiratory medication and air pollutants in the Brussels-Capital Region between 2005 and 2011. MethodsWe used over-dispersed Poisson Generalized Linear Models to regress daily individual reimbursement data of prescribed asthma and COPD medication from the social security database against each subject's residential exposure to outdoor particulate matter (PM10) or NO2 estimated, by interpolation from monitoring stations. We calculated cumulative risk ratios (RR) and their 95% confidence intervals (CI) for interquartile ranges (IQR) of exposure for different windows of past exposure for the entire population and for seven age groups. ResultsMedian daily concentrations of PM10 and NO2 were 25μg/m3 (IQR=17.1) and 38μg/m3 (IQR=20.5), respectively. PM10 was associated with daily medication sales among individuals aged 13 to 64y. For NO2, significant associations were observed among all age groups except >84y. The highest RR were observed for NO2, among adolescents, including three weeks lags (RR=1.187 95%CI: 1.097–1.285). ConclusionThe associations found between temporal changes in exposure to air pollutants and daily sales of respiratory medication in Brussels indicate that urban air pollution contributes to asthma and COPD morbidity in the general population.

Perceptions and Attitudes of Medical Sales Representatives (MSRs) and Prescribers Regarding Pharmaceutical Sales Promotion and Prescribing Practices in Pakistan

: Introduction: Pakistan is the 6th most populous country in the world and has an enormous potential for an ever increasing drug market. The health care system is highly prone to unethical drug prescribing practices. In addition, there is a huge tendency of pharmaceutical firms to indulge in unethical drug promotional practices by means of inducements and other benefits through their medical sales representatives (MSRs). On the other hand, the prescribers are also reported to be demanding inducements from these companies in return to write higher number of prescription. This study investigated the ground realities of drug promotion and prescribing practices in Pakistan. Materials and Methods: A cross sectional study was conducted for a period of 6 months in which 472 physicians and 609 medical sales representatives of Pakistan selected through prospective sampling were interviewed on a validated, structured questionnaire. The responses of the target groups were then analyzed for association between variables by Chi–square test (p<0.05) and cross tabulation through SPSS, version 20. Results: Majority of practitioners (83.2%) expected both, good communication skills and knowledge from MSRs and at the same time nearly 53% of prescribers demanded CME and almost 36% demanded gifts, incentives and inducements from MSRs. Replying to same question, MSRs disagreed with prescribers and believed that ~70 % of prescribers ask for inducements with a whopping ~64 % among them demanding unethical inducements like excessive free samples, gifts, leisure trips and even cars. Majority of physicians have consensus that the multinational pharmaceutical firms (92 %) have defined promotional practices while the national pharmaceutical companies (~73 %) are mainly involved in unethical practices of drug marketing. Conclusion: Majority of national pharmaceuticals as well as prescribers were involved in unethical drug promotion and prescribing respectively. There is a need of curbing the unethical drug promotion and prescribing and formidable policies governing this issue are required to be implemented by the concerned regulatory authorities to avoid unnecessary harm to the patient’s life and pocket. Strength and weakness of study: The study explored the drug promotion and prescribing practices for the first time in a developing country however, due to sensitivity of the topic a number of respondents hesitated to participate.Key words: Drug, Drug detailing, CME, Medical sales representative, Physicians, Pakistan.

The Revolving Fund Pharmacy Model: backing up the Ministry of Health supply chain in western Kenya.

A pressing challenge in low and middle-income countries (LMIC) is inadequate access to essential medicines, especially for chronic diseases. The Revolving Fund Pharmacy (RFP) model is an initiative to provide high-quality medications consistently to patients, using revenues generated from the sale of medications to sustainably resupply medications. This article describes the utilization of RFPs developed by the Academic Model Providing Access to Healthcare (AMPATH) with the aim of stimulating the implementation of similar models elsewhere to ensure sustainable access to quality and affordable medications in similar LMIC settings. The service evaluation of three pilot RFPs started between April 2011 and January 2012 in select government facilities is described. The evaluation assessed cross-sectional availability of essential medicines before and after implementation of the RFPs, number of patient encounters and the impact of community awareness activities. Availability of essential medicines in the three pilot RFPs increased from 40%, 36% and <10% to 90%, 94% and 91% respectively. After the first year of operation, the pilot RFPs had a total of 33 714 patient encounters. As of February 2014, almost 3 years after starting up the first RFP, the RFPs had a total of 115 991 patient encounters. In the Eldoret RFP, community awareness activities led to a 51% increase in sales. With proper oversight and stakeholder involvement, this model is a potential solution to improve availability of essential medicines in LMICs. These pilots exemplify the feasibility of implementing and scaling up this model in other locations.

Direct-to-Consumer Sale of Prescription Drugs by Pharmaceutical Companies: An Assessment of the Patient Experience?

Background. Direct-to-consumer sale of prescription medications by pharmaceutical companies has emerged as a novel delivery method. It is important to ensure that patients who choose this method are receiving adequate pharmaceutical care that meets established practice standards. Objective. The objective of this study was to assess consultation for patients who are receiving medications via direct-to-consumer sales of prescription drugs from pharmaceutical companies. Methods. We conducted a blinded telephone survey using 10 mock prescriptions for simulated patients (secret shoppers) by contacting the 2 companies currently offering prescription medications for sale directly to consumers. Results. Simulated patients in this pilot study only had a pharmacist initiate consultation for 20% of the calls. Multiple pharmacy technicians offered consultation and this behavior does not follow state statutes. In addition, technicians also failed to forward calls to the pharmacist-on-duty, instead suggesting the patients contact their physicians. On a further direct request to speak to a pharmacist, a consultation did occur for 90% of the calls. However, the consultation failed to achieve practice standards set by Omnibus Budget Reconciliation Act of 1990 and the state statutes for the majority of the encounters. Conclusion. These results warrant a larger scale study of consultation for direct-to-consumer prescription sales. In addition, they highlight areas for training needed for all pharmacy personnel who work in this venue.

Complementary or competing climates? Examining the interactive effect of service and ethical climates on company-level financial performance.

By bending rules to please their customers, companies with high service climates may be less ethical but ultimately more profitable. In this article, we pose the question of whether being ethical comes at a cost to profits in customer-oriented firms. Despite the organizational reality that multiple climates coexist at a given time, research has largely ignored these types of questions, and the simultaneous analysis of multiple climate dimensions has received little empirical attention to date. Given their scientific and practical importance, this study tested complementary and conflicting perspectives regarding interactions between service (outcome-focused) and ethical (process-focused) climates on company-level financial performance. Drawing on a sample of 16,862 medical sales representatives spread across 77 subsidiary companies of a large multinational corporation in the health care product industry, we found support for a complementary view. More precisely, results revealed that profitability was enhanced, not diminished, in service-oriented firms that also stressed the importance of ethics. Results suggest studying the interactive effects of multiple climates is a more fruitful approach than examining main effects alone. (PsycINFO Database Record

Quality of assessment and counselling offered by community pharmacists and medication sale without prescription to patients presenting with acute cardiac symptoms: a simulated client study.

Self-medication is common worldwide. However, the prevalence of sale of prescription medications without prescription and the quality of assessment and counselling provided by community pharmacists to cardiac patients is unknown. We sought to determine the prevalence of prescription medication sales and explore how pharmacists assess and counsel patients with acute cardiac conditions. Six hundred community pharmacies in the two largest cities in Saudi Arabia were selected. Two simulated clients presented either an acute coronary syndrome (ACS) scenario or an acute heart failure (AHF) scenario to the pharmacists. Descriptive statistics and regression models were used to analyse and present the collected data. Of 600 pharmacies, 379 (63.2%) sold various prescription medications to simulated patients without prescription. Assessment and counselling provided by pharmacists were inadequate. Almost a quarter of pharmacists did not ask simulated patients any questions; 52% asked one or two questions; and only 24% asked three or more questions. Only 28 pharmacists (4.7%) inquired about drug allergies; 48.5% instructed simulated patients on the dosage and frequency of the sold medications; 21.6% provided instruction on treatment duration; and 19.4% gave instructions on dose, frequency, and duration of treatment. Compared to AHF, ACS simulated patients were more likely to be asked about other symptoms and comorbidities (59.7% vs. 48.7%, p = 0.007 and 46.3% vs. 37.3%, p = 0.005, respectively) and were more likely to be advised to go to hospital (70.3% vs. 56.3%, p < 0.001). The sale of prescription medications by community pharmacists to simulated cardiac patients without prescription is very common; assessment and counselling qualities are suboptimal.