Separation Of Prescribing Research Articles

Optimal design of healthcare services after the separation of prescribing and dispensing

Healthcare services are customer-intensive services and usually accompanied by other treatment-related consumptions, e.g. medications. Traditionally in China, prescribing and dispensing are both made by hospitals, which causes high drug expenses. To solve this problem, the Chinese government has begun exploring the separation of prescribing and dispensing. Against this background, this paper analyses the optimal designs for healthcare services considering separated medications. We consider a service system with one monopolistic healthcare service provider, which could be a revenue-maximiser or social-welfare maximiser, and assume patients are bounded-rational with demands affected by price and quality of both service and medications. We analyse the optimal service price and service rate for cases involving either single or multiple medications. Revenue-maximiser usually prefers cost-effective medications, and when its service quality is low, more irrational patients are preferred. Its revenue increases with the number of medication types. For the social-welfare-maximiser, as the number of medication types or improved quality of certain medications does not ensure greater social welfare, its benefits depend on the prices and quality of the entire medications. For a social planner, it is effective to institute price caps to achieve socially optimal results. This paper lays theoretical foundations for price regulations of public healthcare systems.

An Evaluation of Prescriptions Dispensed in Malaysian Community Pharmacies in the Absence of Dispensing Separation

The separation of prescribing and dispensing remains a topic of intense debate in many countries without such a separation policy, including Malaysia. While most patients in these countries obtain their medicines from the prescribing physician themselves, some patients may choose to get their prescriptions filled at a community pharmacy. In this study prescription records of community pharmacies were analysed to evaluate utilization of pharmacy dispensing services with reference to prescription rate, origin of prescription, and therapeutic class of medications dispensed. A total of 982 prescriptions from 20 community pharmacies, comprising of 2181 medications, were analyzed. The mean prescription rate was 6.13 prescriptions per pharmacy per month. Most of the prescriptions originated from private hospitals (57.0 %), followed by private clinics (28.9 %) and public institutions (12.6 %). The top three therapeutic classes of medication dispensed were cardiovascular (30.3 %), alimentary tract (19.2 %), and antiinfectives (15 %). Chain pharmacies received significantly more prescriptions compared to independent pharmacies. Chain pharmacies were also more likely to receive prescriptions from private hospitals (p<0.001), whereas independent pharmacies were more likely to receive prescriptions from private clinics (p<0.001). Overall, utilization of pharmacy dispensing services remains low in the absence of dispensing separation. Patients that fill their prescriptions at community pharmacies are likely driven by cost factors and on long-term medication. The public should continue to be educated regarding dispensing separation and the options available when obtaining their medication.

Comparison of medicines management strategies in insurance schemes in middle-income countries: four case studies

BackgroundMany middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on the strategies used in middle-income countries. This paper compares the medicines management strategies that four insurance schemes in middle-income countries use to improve access and cost-effective use of medicines among beneficiaries.MethodsWe compare key strategies promoting cost-effective medicines use in the New Rural Cooperative Medical Scheme (NCMS) in China, National Health Insurance Scheme in Ghana, Jamkesmas in Indonesia and Seguro Popular in Mexico. Through the peer-reviewed and grey literature as of late 2013, we identified strategies that met our inclusion criteria as well as any evidence showing if, and/or how, these strategies affected medicines management. Stakeholders involved and affected by medicines coverage policies in these insurance schemes were asked to provide relevant documents describing the medicines related aspects of these insurance programs. We also asked them specifically to identify publications discussing the unintended consequences of the strategies implemented.ResultsUse of formularies, bulk procurement, standard treatment guidelines and separation of prescribing and dispensing were present in all four schemes. Also, increased transparency through publication of tender agreements and procurement prices was introduced in all four. Common strategies shared by three out of four schemes were medicine price negotiation or rebates, generic reference pricing, fixed salaries for prescribers, accredited preferred provider network, disease management programs, and monitoring of medicines purchases. Cost-sharing and payment for performance was rarely used. There was a lack of performance monitoring strategies in all schemes.ConclusionsMost of the strategies used in the insurance schemes focus on containing expenditure growth, including budget caps on pharmaceutical expenditures (Mexico) and ceiling prices on medicines (all four countries). There were few strategies targeting quality improvement as healthcare providers are mostly paid through fixed salaries, irrespective of the quality of their prescribing or the health outcomes actually achieved. Monitoring healthcare system performance has received little attention.

Voluntary work of pharmacy students in two regions of South Korea without the separation of the dispensary from medical practice

Abstract: Background: Participation in a medical volunteer work positively affects some of the beliefs and perceptions of pharmacy students. However, the volunteer activities by pharmacy students have been rarely performed and studied in Korea. The objectives of this study were to introduce the volunteer activities by pharmacists and pharmacy students at the medically underserved regions without separation of prescribing and dispensing in Korea and to determine health conditions and prevalence and management of chronic diseases (CDs) in the residents of these regions. Methods: Survey instruments consisting of 23 questions were administered to the residents who visited the temporary pharmacy during the volunteer services. Results: A total of 352 residents completed the survey, and 66.3% of residents were over 70 years old. More than 12% of residents responded that their health conditions were good, and 76.5% of residents had at least 1 CD. Over 73% of residents responded that they took all doses of medications prescribed while 5.7% of residents answered that they missed all those of them. Conclusions: Through the volunteer activities, pharmacists and pharmacy students will play a meaningful role in providing a medical care in order to effectively manage CDs at the medically underserved areas in Korea. Key words: Volunteer works, Korean pharmacy students, Medically underserved areas, Advanced pharmacy practice experience.

Separation of prescribing and dispensing in Malaysia: the history and challenges.

This article serves as an update to the work by Shafie et al. (2012) which previously reviewed the benefits of policies separating prescribing and dispensing in various countries to advocate its implementation in Malaysia. This article seeks to strengthen the argument by highlighting not only the weaknesses of the Malaysian health care system from the historical, professional and economic viewpoints but also the shortcomings of both medical and pharmacy professions in the absence of separation of dispensing. It also provides a detailed insight into the ongoing initiatives taken to consolidate the role of pharmacists in the health care system in the advent of separation of dispensing. Under the two tier system in Malaysia at present, the separation of prescribing and dispensing is implemented only in government hospitals. The absence of this separation in the private practices has led to possible profit-oriented medical and pharmacy practices which hinder safe and cost-effective delivery of health services. The call for separation of dispensing has gained traction over the years despite various hurdles ranging from the formidable resistance from the medical fraternity to the public's scepticism towards the new policy. With historical testament and present evidence pointing towards the merits of a system in which doctors prescribe and pharmacists dispense, the implementation of this health care model is justified.

The Relationship between Medication Adherence and Medical-service Evaluation among Chronically-diseased Outpatients under the Separation of Prescribing and Dispensing: An Empirical Study Aiming at Reducing Unused Medicines and Promoting Family Pharmacies

The Relationship between Medication Adherence and Medical-service Evaluation among Chronically-diseased Outpatients under the Separation of Prescribing and Dispensing: An Empirical Study Aiming at Reducing Unused Medicines and Promoting Family Pharmacies

메디컬빌딩의 건축계획특성 연구 - 청주지역을 중심으로

Purpose: Under a trend of hospitals that repeated expansion in line with fast increasing factors of medical demands in the past, medical buildings where clinic businesses have regularly gathered in one building have exponentially increased since separation of prescribing and dispensing in 2000. Thus, this study aims at analyzing characteristics of architectural plan of the current medical buildings, identifying strengths and weaknesses through Post Occupancy Evaluation and suggesting an architectural planning method of medical buildings to be planned in the future. Methods: Scope of study has been limited to 23 medical buildings that are registered in the building register as medical buildings out of the Class 1 neighborhood facilities build as 5 floors or more in Cheongju region since 2000 and being actually used for the usage. Study method is to define concepts of the medical buildings through literature review and advanced researches, analyze characteristics of architectural plan through drawing analysis and site survey. Results: General characteristics of architectural plans for the medical buildings in Cheongju have been analyzed. There are the most frequencies in general commercial area and semi-residential area, most of them are reinforced concrete structure and the Class 1 neighborhood facilities. Average land area is , gross floor area , the number of underground floors level 1.16, the number of floors level 7.76, total number of floors 8.92, the building-to-land ratio 67.28%, floor area ratio 452.6%, height 31.44m, and the number of parked vehicles 24.16. Implications: This research will contribute to the establishment of the planning methods which increase the quality of Medical Buildings in Cheongju.

Policy Learning without a Policy Guide? A Pilot Program for the Separation of Prescribing and Dispensing in Korea 1981-1985

Policy Learning without a Policy Guide? A Pilot Program for the Separation of Prescribing and Dispensing in Korea 1981-1985

Separation of Prescribing and Dispensing in Korea

Separation of Prescribing and Dispensing in Korea

The Study on Service Design Development for Pharmacy Users: Using Smart Phone Application

Objective: This study is to review the current state of services offered to pharmacy users, and develop a service design converging a prescription service and a smart phone application service in order to enhance patients’ experience at pharmacies and home. Background: Under the new medical system; separation of prescribing and dispensing drugs, a doctor writes a prescription to their patients and patients have their prescription filled at the pharmacy. As the number of flue, allergy and atopy patients has increased, waiting lines have been longer at pharmacies. Besides, the current medical service system lacks of providing proper information on prescribed pills to patients. There are already services offered during waiting times such as offering free drinks, magazines or suggesting general drugs which you can buy without prescription, however they neither cover the current medical service’s shorts nor shorten the waiting time. Method: I researched objective and perceived waiting times reduction methods, the current service status at pharmacies, and the government’s policy direction in a medical service. Also, I observed a patient’s journey from the hospital to pharmacy and then horne. I examined the circumstance at pharmacies, patients’ behaviors and their thoughts during their journey, and extracted three main goals to design a service in order to help patients have positive perception during the waiting time; (1) to reduce the perceived time by the way of visualizing time and offering readings about what patients consider necessary, (2) to educate patients what they are into and how to get through, (3) to establish trust among patients, doctors and pharmacists. Based on three goals, I designed a structure and a wireframe for a new service application of smart phones. Results: With a new service design for pharmacy users, users can track their medical record and visit the information about their current medical treatments anytime. Also the service helps patients build reliable relationships with doctors and pharmacists. Conclusion: Experience is not just an activity but series of multiple activities. The serving range of a medical service should not be determined by stakeholders but user’s holistic experience. By approaching a service design with a holistic vision, it can enrich not only a temporary experience but also a whole life well being. Application: Since there are already many service applications advising patients about their illness and finding right doctors, this service design is focused on the experience from getting a prescription till feeling better. The next move is to combine those two parts medical services and design an integrated service application. As a prescription is going to be coded in numbers, we might consider to design an un-attended pharmacy which can shorten huge amount of time for filling prescriptions.

Insights on public hospital corporate governance in Shenzhen

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals, the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means. Key words: Public hospitals; Corporate governance; Reform; Experiment

A DRUG SAFETY RISK MANAGEMENT AND ASSESSMENT MECHANISM FOR COMMUNITY PHARMACY IN TAIWAN

Pharmacy is a specialized service industry, with unique inherent risks different from other industries. The biggest risk source of the pharmacy industry is ”Medication Error”. As our community enters into an aging society and the policy of separation of prescribing and dispensing gradually matures, the importance of drug safety of the community pharmacy increases. This study applies the grounded theory to find the critical risk factors of medication error from the literature review, adopts the Delphi method to revise these factors and uses the analytic hierarchy processing methodology to analyze each element in our proposed drug safety risk management and assessment mechanism. This study contributes to the community pharmacy by developing the drugs safety assessment model to help the pharmacy to have a better understanding of the risk factors associated with its day-to-day business operations and to provide references to pharmacists in setting up more complete risk management strategies in the future.

Pharmaceutical Policy in Hong Kong: Defining an Evolving Area of Study

Background: Hong Kong as a developed economy in Asia still lags behind other advanced economies of the OECD in medicines regulation and the promotion of pharmacists’ professionalism. It lacks a significant local drug industry, and has only recently placed priority on cost-containment measures for pharmaceutical expenditures. This latter has increased politicization of pharmaceutical issues and sets the ground for a serious study of the policy processes affecting medicines and the stakeholders involved, both of which have hitherto not been researched locally. Objectives: To review pharmaceutical policy developments in Hong Kong and to identify the major policy debates regarding pharmaceuticals in recent years (2002-2006) with the view of studying the characteristics of these policy processes and activities. Methods: Documentary analysis method using minutes of meetings of the health services panel in the legislature and documents and position papers issued by various stakeholder groups. The framework for analysis is based on components of the policy cycle. Relevant policy process models and various theories are employed as tools to aid understanding of the policy activities. Results and Discussion: Pharmaceutical policy in Hong Kong is not concerned with issues of regulating the pharmaceutical industry, pharmaceutical R&D and patent protection, and state reimbursement of pharmaceutical payments which are characteristic priorities of policymaking in advanced economies. The ability of public policy to bring forward a new pharmaceutical regulatory framework and promote rational use of medicines is hampered by inadequate exercise of professionalism (muted pharmacist’ role due to lack of separation of prescribing and dispensing), an underdeveloped community pharmacy sector and insufficient integration of the various levels and sectors of healthcare provision. The pharmaceutical regulatory agency in Hong Kong remains conservative in outlook but is facing similar strain of challenge from the pharmaceutical sector despite the issues raised are of plain trade and business rather than industrial policy in nature. Description of the policy process is benefited by adapting the ‘stages heuristic’ framework. Both garbage can and policy streams models are useful in providing for an explanation of policy change.Conclusion: In the absence of an integrated framework, pharmaceutical policy formulation will likely remain ad hoc and continue to revolve around the ongoing wider discussions about health care reform. The problems faced by policymakers in formulating pharmaceutical policy in Hong Kong represent a different picture from Western countries where medicines policy in the latter naturally subsumes industrial policy, healthcare policy and public health policy under one rubric. This peculiarity may not be unique to Hong Kong but is perhaps reflective of other small jurisdictions as well.

A DRUG SAFETY RISK MANAGEMENT AND ASSESSMENT MECHANISM FOR COMMUNITY PHARMACY IN TAIWAN

ABSTRACT Pharmacy is a specialized service industry, with unique inherent risks different from other industries. The biggest risk source of the pharmacy industry is “Medication Error”. As our community enters into an aging society and the policy of separation of prescribing and dispensing gradually matures, the importance of drug safety of the community pharmacy increases. This study applies the grounded theory to find the critical risk factors of medication error from the literature review, adopts the Delphi method to revise these factors and uses the analytic hierarchy processing methodology to analyze each element in our proposed drug safety risk management and assessment mechanism. This study contributes to the community pharmacy by developing the drugs safety assessment model to help the pharmacy to have a better understanding of the risk factors associated with its day-to-day business operations and to provide references to pharmacists in setting up more complete risk management strategies in the future.

The Economics of Pharmaceutical Pricing and Physician Prescribing in Japan

A country's pharmaceutical policy is unique, just like its culture. Japan is no exception. Japan has employed a unique dynamic price-control rule that updates regulated retail prices based on the previous period's transaction prices. At the same time, separation of prescribing and dispensing has historically been weak, and the doctor can both purchase and sell a drug to his patient. These policies allowed the physician to earn the price-cost markup, and this appears to have affected physician prescribing. After discussing these features in more detail, I review two recent studies that empirically investigated their impacts on physician prescribing. Ongoing changes in pharmaceutical policy and their expected impacts are also discussed.

Assessment of Japanese Pharmacists' Perceptions towards Community Pharmacy

The objectives of this study were to 1) describe Japanese pharmacists' perceptions about community pharmacy on a variety of issues and 2) compare the perceptions between different groups.A questionnaire was administered to a convenience sample of community pharmacists in the Tokyo metropolitan area and Hiroshima prefecture. Pharmacists were surveyed on various issues such as job satisfaction, the separation of prescribing and dispensing, their relationship with patients and physicians, and pharmacy education. A five-point Likert scale was used to measure responses and ranged from 1=strongly disagree to 5=strongly agree.One hundred forty-four questionnaires were completed. Eighty-four percent of respondents were female, 37.5% had more than ten years of practice experience, and 81.9% worked in Tokyo. Japanese community pharmacists are neutral or satisfied with their jobs. However, respondents were not satisfied with the current state of community pharmacy in Japan (2.81±0.83), did not feel respected by patients (2.74±0.99) and physicians (1.99±0.95), felt that four years of education was not enough to provide adequate patient care (1.96±1.01), and would like to do more clinical oriented activities (3.77±0.84). Significant differences were found in some responses between groups such as males versus females and pharmacists with more versus less than ten years of practice experience.Respondents were not satisfied with the current state of community pharmacy in Japan. Areas that could use improvement are respect from patients and physicians, involvement in clinical activities, and assistance at work. Significant differences were found in the perceptions of the groups studied.

5 Years' Evaluation of 'the Separation of Prescribing and Dispensing Roles' Policy on Medical Institutions

5 Years' Evaluation of 'the Separation of Prescribing and Dispensing Roles' Policy on Medical Institutions

Current Situation for Generic Drugs in Japan

Although the Japanese pharmaceutical market is the second largest market in the world, the share of generics is extremely low when compared with those in the USA, the UK and Germany. The reason for this is that there are several obstacles to quick access to, and market penetration of, generics that would be incomprehensible to foreign companies. In Japan, systems such as substitution of generics for brands, reference pricing, etc have not yet been implemented. Similarly, the complete separation of prescribing and dispensing medicines has not occurred in Japan, where 48 per cent of medical institutions both prescribe and dispense pharmaceutical products. This is in stark contrast to both the USA and the EU, where complete separation exists. Medical institutions that gain profits from the gap between the purchasing and reimbursement price still tend to use brands with higher profit margins than generics; however, the push to promote the use of generics has just started. Therefore, generics companies and their associations must implement appropriate strategies in response to the changing circumstances.

Problems of the Separation of Prescription and Dispensing

AbstractFor Abstract see ChemInform Abstract in Full Text.

Problems of the separation of prescription and dispensing

By October 2002, the separation of prescribing and dispensing in Japan had already been implemented for 28 years since the system was inaugurated in 1974. Although the separation rate reached 44.5% in 2001, the questions, "Is the separation necessary in Japan?" or "Has the system been working successfully?" are often heard. These questions are raised because people have not noted the advantages of the system yet, and because the separation itself has many problems or shortcomings. These questions are not only from pharmacists, but also from physicians, patients, or medical and educational institutions. If the problem concerns pharmacists, it is assumed to stem from their lack of ability required for the separation. A breakthrough for an early solution of the problem will be found in a change in education, which includes a range of clinical subjects and long-term clinical practices.