Medical Sales Research Articles

Residential green space and mental health-related prescription medication sales: An ecological study in Belgium

BackgroundResidential green space has been associated with mental health benefits, but how such associations vary with green space types is insufficiently known. ObjectiveWe aimed to investigate associations between types and quantities of green space and sales of mood disorder medication in Belgium. MethodsWe used aggregated sales data of psycholeptics and psychoanaleptics prescribed to adults from 2006 to 2014. Generalized mixed effects models were used to investigate associations between relative covers of woodland, low-green, grassland, and garden, and average annual medication sales. Models were adjusted for socio-economic background variables, urban-rural differences, and administrative region, and included random effects of latitude and longitude. ResultsUrban census tracts were associated with 9–10% higher medication sales. In nationwide models, a 10% increase in relative cover of woodland, garden, and grass was associated with a 1–2% decrease in medication sales. The same association was found for low green but only for men. In stratified models, a 10% increase in relative cover of any green space type in urban census tracts was associated with a decrease of medication sales by 1–3%. In rural census tracts, no protective associations between green space and mood disorder medication sales were observed, with the exception of relative woodland cover for women (−1%), and low green was associated with higher medication sales (+6–7%). ConclusionsTaken together, these results suggest that living in green environments may be beneficial for adult mental health. Woodland exposure seemed the most beneficial, but the amount of green space was more important than the type. Results underline the importance of conserving green space in our living environment, for the conservation of biodiversity and for human health.

The Russian pharmaceutical market: the main trends of development and pricing in modern conditions

The National Russian pharmaceutical market is exposed to strong impact of external environment therefore its transformation is inevitable. Yet, development of market is strategically important for Russia that requires permanent monitoring and timely development of normative documents and target programs focused on supporting of population social guarantees. The global digitization of all industries, including pharmaceutical revealed urgent necessity in shifting accents to area of internet-marketing and internet-trade while elaborating rules of realization of sales of medications. The economical and political actualities of further advancing of concept of import substitution, development of mechanisms of state support of all agents of pharmaceutic market and also strategy of pricing considering transition of trade process to digital rails.

Plague Years: A Doctor's Journey through the AIDS Crisis

Plague Years: A Doctor's Journey through the AIDS Crisis

More states allow sales of OTCs in vending machines

Pharmacists may notice that some OTCs they stock in their pharmacies are now appearing on the rotating coils inside an increasing number of vending machines alongside chips and crackers. Late last year, Maryland lifted its decades-old ban on the sale of OTCs in vending machines, leaving Connecticut, Wisconsin, and Oklahoma as the only 3 states that continue to uphold such bans. This additional access point to pain relievers, allergy meds, and contraception may not change the landscape for pharmacy and pharmacy practice, but it will add to a landscape in which access to both medication and health care in general has been increasing. “The pandemic has proved to us that health care is changing, and pharmacy is a part of health care,” said Stefanie Ferreri, PharmD, professor and chair of the division of practice advancement and clinical education at University of North Carolina’s Eshelman School of Pharmacy. “We are rethinking how health care is delivered, and that includes how medications get to patients.” There’s no federal law that prohibits the sale of OTC medications in vending machines, but many states have banned the practice over the last 50 years or so. During this time, however, consumers have had many points of access to OTC products outside of the pharmacy, including grocery stores, gas stations, corner stores, and more recently the Internet. “I don’t see this changing the landscape,” said Lisa Kroon, PharmD, professor of clinical pharmacy and department chair at the University of California, San Francisco School of Pharmacy. Instead, vending machines that carry OTC products add to an environment where access to medication and to health care in general has been increasing. The machines join home delivery, curbside pickup, and mail order pharmacy, among other new modes of medication delivery. In this current pandemic and flu season, vending machines may offer the added advantage of cutting down on unnecessary foot traffic at brick-and-mortar stores. “The convenience of it is certainly a big advantage,” Ferreri said. In some parts of the country, this kind of access may provide a greater advantage than in others. In a February 2021 report urging Maryland lawmakers to lift the ban on vending machine sales of OTC drugs, bill sponsor Robbyn Lewis (D-Baltimore) pointed out that many people live in pharmacy deserts. As for those who live near a pharmacy, only 5% of those stores are open 24 hours. But in these remote areas, one should ask how often vending machine products turn over or get restocked, Kroon noted. “How long are these medications just sitting in there? Who’s checking expiration dates? Even at a corner store, you’d think turnover would be a little higher,” she said What’s more, while pharmacy deserts tend to be found in low-income areas, vending machines may not provide affordable access to OTC medication. “You’re not going to get the choice of the store brand in a vending machine, and those are a whole lot cheaper,” Kroon said. While the machines may dispense pain, cold, and allergy relief medications, they cannot dispense a pharmacist’s advice. Though they only stock OTCs, many consumers are unaware that these types of products could cause interactions with their prescription medications or could interact with existing health conditions. “A pharmacist is a great health care professional for advice on over-the-counter medicines,” Ferrari says. “In fact, we’re the only health care professionals trained in over-the-counter medicines. So that’s a big disadvantage of these vending machines.” But pharmacists still have the opportunity to dispense advice on OTCs after vending machine sales. The sale of OTC drugs in vending machines simply underscores the need for pharmacists to inquire about OTCs and supplements when patients pick up prescriptions, if possible, and certainly during medication reviews. “You as the pharmacist may need to tell them about those OTC medications and the possible risks, since many patients assume they are always safe since you don’t need a prescription,” Ferreri said. “I usually have to ask the question in 2 or 3 different ways before I find out that they’e taking several over-the-counter medicines. So make sure that you ask and double-ask your patients what they’re taking.”

Analysis of factors influencing pharmaceutical sales workforce engagement in pharmaceutical marketing in Nigeria: a structural equation modeling approach

In the pharmaceutical sales and marketing industry, human capital in terms of the sales workforce is essential to organizational success. However, there is a need to ensure that the task-environment is adequately resourced. The application of structural equation modeling (SEM) techniques such as factor analysis is necessary to further understand the underlying relevance of these factors. The objective of the study was to explore the factors influencing pharmaceutical sales personnel's work engagement in pharmaceutical companies using factor analysis. A cross-sectional, qualitative research study used an 11-item literature-guided questionnaire administered online to 406 medical sales professionals in the pharmaceutical supply network in Nigeria using random sampling. The factors evaluated include regularity and impact of training, marketing support, job security as perceived by the employee, incentives, reward for performance, and the prospect of promotion. Others include; minimal work stress, improved career prospects, and an enabling work environment provided for employees involved in pharmaceutical sales operations. The questions were rated on a 3-point Likert scale of 1=fair, 3=poor, and 5=good, to evaluate respondents’ estimation of factors. Exploratory factor analysis (EFA) was executed on the dataset and thereafter, confirmatory factor analysis (CFA) was conducted on the dataset using SPSS AMOS. Statistical significance was set at p-value < 0.05. The majority of respondents were male (72.2%, 293) and female (27.8%, 113). Respondents from Indigenous firms were predominant (249, 61.3%) compared to Multinational firms (157, 38.7%). There were 289 (71.2%) non-pharmacists and 117 (28.8%) pharmacists. EFA measures of adequacy were satisfactory (Kaiser-Meyer-Olkin=0.878, Goodness-of-fit=0.023, Cronbach alpha=0.859, Total variance explained= 51.6%) and produced a 2-factor solution consisting of 9-items (work factors=6, implied factors=3). CFA solution from EFA output produced satisfactory fit estimates (RMSEA=0.044, CMIN/DF=1.787, GF1=0.977, AGFI=0.957, RMR=0.029, and TLI=0.981). The final model had acceptable convergent and discriminant validity values. Job security was considered as the most influential factor (regression coefficient=0.859) and the least was work-life balance (regression coefficient=0.559). The study provided a validated tool to evaluate the pharmaceutical sales workforce’s estimation of the key factors influencing job performance. This serves as an operational template for strategic managers in pharmaceutical companies to improve employee’s perception of management support.

The Trend in the Sales of Menopausal Hormone and Other Osteoporosis Medications in South Korea from 2016 to 2019.

BackgroundIncreasing geriatric population, osteoporosis prevalence, and interest in bone health are key contributing factors for the growth of osteoporosis medication markets. Thus, this study evaluated changes in the menopausal hormone and other osteoporosis medication markets from 2016 to 2019.MethodsThis study’s dataset was obtained from the International Marketing Services of IQVIA Inc. in South Korea. The sales of medications for osteoporosis treatment with menopausal hormones were evaluated for drug sales for osteoporosis treatment from 2016 to 2019.ResultsThe results showed that the tissue-selective estrogen complex (TSEC) sales had increased annually while the estrogen-progesterone therapy (EPT) sales had decreased. Excluding menopausal hormones, bisphosphonates were the most widely sold medications for osteoporosis treatment. Among the bisphosphonate medications, sales of ibandronate and zoledronate increased annually, while alendronate and risedronate decreased. Teriparatide also showed increasing sales. A rapid rise was noted in the sales of denosumab.ConclusionsWhile the sales of TSEC, injectable bisphosphonates, and denosumab have increased annually, the sales of EPT, estrogen therapy, oral bisphosphonates have not increased, as reflected in hormone therapy and osteoporosis medication market trends. This study showed the recent trends in hormone therapy and the osteoporosis medication market from 2016 to 2019 in South Korea.

Patterns of prescription dispensation and over-the-counter medication sales in Sweden during the COVID-19 pandemic.

On February 26th 2020, a high alert was issued in Sweden in response to the diagnosis of the first few coronavirus disease 2019 (COVID-19) cases in the country. Subsequently, a decreased supply of essential goods, including medical products, was anticipated. We aimed to explore the weekly patterns of prescription dispensing and over-the-counter (OTC) medication sales in Sweden in 2020 compared with previous years, to assess the influence of the government restrictions on medication sales, and to assess whether there is evidence of medication stockpiling in the population. Aggregated data on the weekly volume of defined daily doses (DDDs) of prescription medication dispensed and OTC sales from 2015 to 2020 were examined. From 2015-2019 data, the predicted weekly volume of DDDs for 2020 was estimated and compared to the observed volume for each ATC anatomical main group and therapeutic subgroup. From mid-February to mid-March 2020, there were increases in the weekly volumes of dispensed medication, peaking in the second week of March with a 46% increase in the observed versus predicted number of DDDs dispensed (16,440 vs 11,260 DDDs per 1000 inhabitants). A similar pattern was found in all age groups, in both sexes, and across metropolitan and non-metropolitan regions. In the same week in March, there was a 96% increase in the volume of OTC sold (2,504 vs 1,277 DDDs per 1000 inhabitants), specifically in ATC therapeutic subgroups including vitamins, antipyretics, painkillers, and nasal, throat, cough and cold preparations. Beginning in mid-February 2020, there were significant changes in the volume of prescription medication dispensed and OTC drugs sold. The weekly volume of DDDs quickly decreased following recommendations from public authorities. Overall, our findings suggest stockpiling behavior over a surge in new users of medication.

Effect of Infodemic Regarding the Illegal Sale of Medications on the Internet: Evaluation of Demand and Online Availability of Ivermectin during the COVID-19 Pandemic.

The COVID-19 pandemic and the related infodemic generated confusion and increased demand of various pharmaceuticals, ushering in the opportunity for illicit online vendors to fill a gap in the marketplace using potentially dangerous products. The aim of our study is to provide evidence regarding increased demand, online availability and consumer accessibility of ivermectin, an anthelmintic agent, without substantiated indications in reference to SARS-CoV-2. In our study, we combined infodemiology methodology aligned with search engine result assessment and website analytics to evaluate patient safety risks. Users’ Google queries regarding ivermectin were trending and peaked during the last week of November 2020 and March 2021. Consumers more likely found links leading directly or indirectly (via redirection) to illegal online retailers representing nearly half (53.3%) of search engine result links regarding the first three result pages in December 2020 and topped off at 73.3% by March 2021. Illicit medicine retailers outnumbered and outranked their legitimate counterparts and dominated the first search engine results page. A vast majority (77.7%) of the identified online pharmacies were characteristically rogue; more than half (55.5%) offered prescription-only products without a valid medical prescription. Our results illustrate connection between infodemic and its consequences on the illicit online pharmacy market

Active learning and instructor accessibility in online talent training: a field experiment in China during COVID-19

Purpose Drawing on self-determination theory (Deci and Ryan, 2012) and Hew’s (2016) five-factor model, our study aimed to investigate the impact of two online training design factors (instructor accessibility and active learning) on learner’s self-efficacy and learning outcome amid the COVID-19 pandemic. Design/methodology/approach A randomized pretest-posttest control group field experiment was designed to assess participants’ self-efficacy and learning outcome of an online training program - territory business management plan, under three conditions: instructor accessibility, active learning, and controlled. Participants (N=87) were medical sales representatives from a Fortune-Global 500 pharmaceutical company’s subsidiary office in China. Data was analyzed with 2 (time) x 3 (group) MANOVA with time (pretest and posttest) as a repeated measure to investigate differences in changes in self-efficacy and learning outcome between three groups. Findings Overall, participants’ self-efficacy and learning outcome were significantly improved via the online training program for all three groups. Specifically, the impact of the training on learning outcome was the strongest for the active learning group, less strong for the instructor accessibility group, and the least strong for the control group. Originality/value Our research contributes towards understandings of the effectiveness of online talent training programs by examining two critical instructional design factors during a time of crisis. Our findings suggest that active learning (interactions with the training materials by purposeful self-reflection) might be a stronger predictor for increasing learning outcome than instructor accessibility (receiving feedback and tutoring sessions from the instructor) for online training programs.

E media and training of pharmaceutical sales representatives in Covid era

Medical sales representatives are a key link between medical and pharmaceutical companies and healthcare professionals. The Medical Sales representative is a high-risk sector with job stress. It requires more skills, wider knowledge and emotional stability than the other professions Due to extensive traveling, and waiting time, target issues, work-life balancing problems and lack of job security the medical representative life cycle is full of psychological stress. E-learning is use of technology for learning outside the boundaries of the physical classroom. New E training modules are more useful which facilitate distance learning, which are safer in new covid era. Product Training can be conferred at specific website created by Pharmaceutical companies.

The Effects of Organizational Absorptive Capacity, Professional Experience and Training over the Use of Sales Force Automation

This research brings out the impact of training and professional experience on organizational absorptive capacity and the use of Sales Force Automation (SFA). A quantitative study was conducted on a sample of 186 medical sales representatives who work in the pharmaceutical industry. The method of structural equations based on the PLS approach and linear regression have been deployed for data analysis. The results reveal a positive impact of the training over organizational absorptive capacity (potential absorptive capacity and realized absorptive capacity) and the use of SFA as well as a positive impact of professional experience on organizational absorptive capacity. Furthermore, the organizational absorptive capacity has a positive influence on the use of the SFA. This study contributes to the literature on SFA use by examining the role of training, professional experience, realized and potential absorptive capacities in the SFA use. This research is appropriate for managers of pharmaceutical companies who constantly seek to improve the use of SFA technologies. Thus, the staff of these companies is more likely to perform their duties in a way that promotes their realized and potential absorptive capacities and the best use of SFA through continuous training for inexperienced and experienced salespeople.

Identification of At-risk Pregnant Population for Over-the-Counter Drug Usage in Low-Resource Settings.

Nearly 1.5 billion people of an Asian country are living their lives without a country-specific over-the-counter (OTC) drug list. A study was planned to assess the understanding and practice of OTC medication consumption in the pregnant population. A questionnaire-based cross-sectional study evaluating different perspectives on OTC drug consumption was planned in around 500 pregnant women attending tertiary care outpatient antenatal clinics. The association of knowledge, attitude and practice versus indications, knowledge regarding harmful effects possible, reasons for choosing OTC medication, the practice of consulting nonmedical persons and drug interactions with the disease or prescription medications was determined. Regression analysis was performed in statistical software R. Seven percent (36/516) of pregnant women were found to consume oral antimicrobials without prescription. Local chemist consultation was the most common channel (72.48%) to procure the OTC medicines. Participants with good knowledge score showed an odds ratio (OR) of 1.87 (95% C.I.; 1.28-2.73), 1.6 (95% C.I.; 0.99-2.63), 1.66 (95% C.I.; 1.14-2.42) and 2.66 (95% C.I.; 1.49-4.89) for self-medication encouragement tendency possible, restricting sale of OTC medications, the habit of reading drug leaflets and understanding the potentially harmful effects, with OTC drugs, respectively. Right-attitude participants showed an OR of 1.89 (95% C.I.; 1.29-2.80) and 1.8 (95% C.I.; 1.19-2.76) for identifying knowledge of acetaminophen overdose and liver damage link as well as the disease symptom masking possibility with OTC, respectively. Participants with insufficient knowledge and attitude scores showed an association with more OTC antacid-antiemetics and analgesic use, respectively. Antenatal pregnant women need to be guided on avoiding OTC antimicrobial usage. Both obstetricians and regulators have to play an active role in educating pregnant women and contributing to developing country-specific OTC drug lists with the guidelines. The online version contains supplementary material available at 10.1007/s13224-021-01481-2.

Comparative analysis of the unregulated sale of antimicrobial prescription medication by drug retailers before and during the COVID-19 pandemic in Abuja, Nigeria

Background: The sustained high-level unregulated sale of prescription medicines in developing countries is recognized as a significant factor in the development of drug resistance among pathogenic microorganisms. Apart from the millions of deaths annually that are attributed directly to antimicrobial resistance to commonly prescribed medicines this major global public health problem hinders achieving the United Nations’ Sustainable Development Goals by its target of 2030. This study compared the extent of the sale of non-prescribed antimalarial medication and of antibiotics before and during the coronavirus disease (COVID)-19 pandemic in each of the six local government areas within the Federal Capital Territory-Abuja, Nigeria. Methods: A structured questionnaire was designed to determine the percentage sales of both antimalarials and antibiotics, without diagnosis or prescription from qualified medical practitioners, over six-month periods between January to June of 2019 and 2020. Results: The data showed that all of the 130 community pharmacies and registered chemist stores where questionnaires were completed engaged in non-prescribed sales of both sets of medicine. Moreover, approximately three-quarters of drug retailers recorded increased patronage in the purchase of both classes of antimicrobial during the 2020 survey period that coincided with the first few months of the COVID-19 pandemic.Over successive years this saw an overall rise in over-the-counter sales of antimalarials and antibiotics (each p p <0.001, respectively) recorded significant increases in indiscriminate sales of each medicine. Conclusion: In line with the high frequency of self-medication, this report points to the threat of possible emergence and spread of multidrug-resistant bacterial and Plasmodium spp. in the Abuja region. These findings highlight the imperative requirement for public health policymakers to implement effective strategies to curb the extensive unregulated sale of prescription drugs in the nation’s capital city and likely elsewhere in Nigeria.

Online medication purchasing during the Covid-19 pandemic: A pilot study from the United Arab Emirates

BackgroundSince the WHO announced that Covid-19 had become a global pandemic, online pharmacies have emerged as an extremely popular way to purchase medication due to the quarantine measures introduced by numerous countries to prevent the virus's spread.AimThe aim of this study was to collect information regarding the extent of online medication purchasing in the UAE and to assess the factors that motivating the purchase of medications from the internet.MethodA convenience sampling of people living in the UAE was used to conduct an online descriptive cross-sectional study. Respondents were solicited using the social media platforms WhatsApp and Facebook, whereby they were asked to fill in a validated web-based questionnaire. The number of people buying medications from online pharmacies was calculated using a percentage with 95% CIs.Results131 respondents (31.2%) [95% CI: 26.7–35.6] stated that they purchased medication via the internet after Covid-19 was classed as a pandemic. It was found that those respondents most likely to have purchased medication via the internet were male, single, and older and with a high school education.ConclusionMore research should be conducted to investigate and compare the self-medication and associated risk factors between online pharmacies and community pharmacies. Moreover, regulatory bodies need to make and implement changes to the regulations that govern the sale and use of medications during COVID-19.

ACCESS TO SINGLE PILL COMBINATIONS IN NATIONAL HYPERTENSIVE CONTROL PROGRAMS: IS PRICING A BARRIER?

Objective: Most patients with hypertension require two or more medicines to control their blood pressure. Single pill combination (SPC) antihypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase patient medication adherence, simplify procurement and distribution. This study uses a private sector pharmaceuticals database to explore whether prices are a barrier to access SPCs in hypertension control programmes. Design and method: Trends in sales of anti-hypertensive medications in India were analysed in private sector pharmaceutical sales dataset from IQVIA Consulting. Price information was collated for medicines that attributed to 70% of sales in terms of number of tablets sold. Maximum Retail Prices of 11 SPCs and their associated Fixed Dose Equivalents (FDEs; same medications and doses as separate pills) were gathered through a publicly available website called “1mg” between November 2019-January 2020. Results: In India, the market share of 2-drug-SPCs and 3-or-more-drug SPCs increased from 2016–2018 at a compounded annual growth rate of 5.5% and 16.1% respectively. In 2018, 2-drug-SPCs (36.3%) had the highest market share in terms of quantity of medicines followed by FDE of SPC components, such as calcium channel blockers (18.3%), beta blockers (16.3%), angiotensin receptor blockers (14.6%), diuretics (5.3%), and ACE-Inhibitors (3.6%). Share of 3-or-more-drug SPCs (2.0%) was very small. While nine of 11 SPCs had an average price higher than sum of the average price of their component FDEs (Range 2.6% - 45.9% higher), a comparison of SPCs and FDEs by the same manufacturer showed that for eight 2-drug-SPCs there was at least one company for each molecule whose SPC was priced lower than the sum of the price of FDEs (Range -71.47% -124.73%). Conclusions: SPCs are increasingly preferred for hypertension treatment in the Indian private sector. The World Health Organization recently included four SPCs for hypertension management in its Essential Medicine List. India has a vibrant and competitive hypertensive medicines market. Examples discovered in this dataset of minimal-to-no price difference suggest that price need not be a barrier to accessing SPCs, and that market forces can further drive down prices with substantial advantages for patients and hypertension control programmes.

Acute liver failure secondary to Ayurvedic Herbal medication in a child: a case report

Ayurvedic and Herbal medicine induced liver injury is rarely reported in children. The injury can range from mild asymptomatic elevation of liver enzymes to severe presentation with acute liver failure leading to death. The diagnosis is by exclusion and relies on accurate history and clinical examination supported by laboratory investigations. Various causality assessments such as council for international organizations of medical sciences (CIOMS) and Roussel Uclaf Causality Assessment Method (RUCAM) have been reported to be useful in reaching the diagnosis of Herbal Induced Liver Injury (HILI). However, these scales have not been validated specifically for pediatric age group. In this report, we present a case of a child who was presented to our department with acute liver failure after taking unlabeled ayurvedic medicine for jaundice and loss of appetite. The child was examined for age specific causes of hepatic injury and acute liver failure and he was managed conservatively. Despite extensive search, we did not find any etiology and suspected herbal medicine induced hepatic injury. She recovered completely after stopping the offending medicines. This case highlights the paradoxical hepatotoxic effect of such medications, widely considered safe and natural by the masses. Pediatric hepatologists and general practitioners should be well aware about such adverse effects of herbal medications when encountered with patients with abnormal liver functions. The health authorities need to establish strict quality check and regulations both in the production and sale of ayurvedic medications.

The Perspective of Therapeutic Antibody Marketing in Iran: Trend and Estimation by 2025.

Background Monoclonal antibodies with high efficiency and specificity are one of the best strategies to diagnose and treat a variety of diseases such as cancer, autoimmunity, and inflammatory diseases. The market for monoclonal therapeutic antibodies (MTAs) has grown dramatically in the past decade. Objective Given the importance of these issues, developing countries spend a high cost on importing or producing MTAs annually. This study intends to examine the market of monoclonal therapeutic antibodies in Iran and predict the future growth rate of this market using the obtained data. Methods Data on the status of MTAs in the country (from 2008 to 2018) were obtained from the Food and Drug Deputy of Mazandaran University of Medical Sciences. The market status of MTAs was studied based on the dosage forms, application, and price. Then, the market outlook was predicted up to year 2025. Results The results showed that 58.8% of all MTAs were humanized, and 86% of all antibody-based drugs were used to treat cancer. Sales of MTA-based medications will reach $454 million by 2025 and are projected to grow significantly in the future. Conclusion Given the increasing technology of the production of MTAs and their use in targeted therapies worldwide, their consumption market in Iran is expected to grow significantly.

Obligatory medical prescription of antibiotics in Russia: Navigating formal and informal health-care infrastructures.

Antimicrobial resistance control programmes often aim to “fix” the behaviour of antibiotic users and prescribers. Such behavioural interventions have been widely criticised in social science literature for being inefficient and too narrow in scope. Drawing on these criticisms, this article analyses how political programmes for fixing antibiotic behaviours were adapted into the practices of health‐care professionals and patients in Russia. In 2018, we conducted interviews with medical doctors, pharmacists and patients in a Russian city; focusing on their practices around the policy requirement introduced in 2017 which obligated medical prescriptions of antibiotics. We conceptualised the obligatory medical prescription as a political technique which sought to change practices of self‐treatment and over‐the‐counter sales of medications by establishing doctors as an obligatory passage point to access antibiotics. Our analysis shows that the requirement for medical prescriptions does not fulfil the infrastructural gaps that influence antibiotic practices. By navigating the antibiotic prescriptions, doctors, pharmacists and patients informally compensate for the gaps in the existing infrastructure creating informal networks of antibiotic care parallel to the requirement of obligatory prescriptions. Following these informal practices, we could map the inconsistencies in the current policy approaches to tackle AMR as a behavioural rather than infrastructural problem.

Current incidence, treatment costs and seasonality of pinkeye in Australian cattle estimated from sales of three popular medications

Pinkeye is an economically important ocular disease occurring in all cattle producing areas of Australia. This study was undertaken to estimate the frequency of occurrence of the disease in Australia and treatment costs of the disease to the cattle industry using the sales of popular pinkeye medications as a surrogate indicator. Monthly sales data for Orbenin® Eye Ointment, Opticlox® Eye Ointment and Terramycin® Pinkeye Aerosol were analysed. We first estimated the number of cattle that can be treated with a syringe or a can and then using the data of sales of these pinkeye medications and the total cattle population of Australia, estimated the incidence of pinkeye. Probability distributions were used to include uncertainty around the estimates. Costs to producers were estimated based on retail prices of these medications. The results indicated that 732,864 syringes of Orbenin® Eye Ointment, 134,800 syringes of Opticlox® Eye Ointment and 27,755 cans of Terramycin® Pinkeye Aerosol are sold in Australia per year. Based on some assumptions of the number of cases treated by these drugs and number of cases left untreated, the number of cattle affected by pinkeye each year in Australia was estimated to be 2.80 million (95 % PI: 1.76, 4.65) or 10.25 % (95 % PI: 6.43, 16.97) of the entire Australian cattle herd. The cattle industry is expected to lose AU$ 9.67 million (95 % PI: 8.56, 13.11) each year just considering the cost of these three drugs. The results suggest that losses due to pinkeye in the Australian cattle industry are considerably higher than previously thought and should be used to inform the development of disease prevention and control policies.

PP290 Exploratory Investigation On Innovative Business Models Of Internet Hospitals In China: A Focus Group Study Of Key Stakeholders

IntroductionUnder the national guidance of Internet Plus Healthcare, Internet hospital was officially recognized in 2018 by the Chinese government, however, how to innovate the business models of Internet hospitals remains controversial. This study sought to explore key stakeholders’ perspectives on key dilemmas about innovative business models of Internet hospitals in China.MethodsA focus group study of key stakeholders was performed. Twelve key stakeholders (six senior officials from related ministries, two industry practitioners of Internet medicine, one hospital leader, two healthcare researchers (financing and policy), and one venture capital manager) participated in the focus group, in 2019. Thematic content analysis was applied for data analysis.ResultsThemes highlighted six key dilemmas when developing a business model of Internet hospitals, including (i) value proposition (medical treatment versus entire health management); (ii) leading party (hospitals versus third parties such as Internet companies); (iii) level of healthcare (tertiary versus primary); (iv) scope of service (provide full range versus part of traditional hospital service); (v) primary source of revenue (medical services versus drug sales); and (vi) legal liability (web-based unit versus physical hospital).ConclusionsThe healthcare industry is currently in search of innovative business models of Internet hospitals in response to the unprecedented form of healthcare in China. However, the core aspects of the model design still remain debatable. At this revolutionary stage, policies are important to allow the implementation of different model designs that support the successful transformation of the entire health care system in China.