Wiley: Journal of Pharmaceutical Health Services Research: Table of Contents

Cost analysis and utilization of antihypertensive drug therapy in Saudi Arabia

Mohammad Daud Ali — Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objectives

Mentioned study is carried out to assess the prescription pattern, utilization of drug and cost analysis of antihypertensive medications used in the treatment of hypertension in a private hospital in Saudi Arabia.

Methods

A retrospective cohort study was carried out in a private hospital in Saudi Arabia. Cost analysis and patterns of outpatient and inpatient antihypertensive drugs used among hypertensive patients between 1 January 2019 and 31 December 2019 were investigated, including incidence, prevalence, duration of use of therapy, class of antihypertensive drugs and therapy for cost-effective use.

Key findings

Monotherapy (78.32%) was leading trends of antihypertensive therapy that followed fixed dose combination with or without multidrug therapy (21.68%). The most frequent antihypertensive class to be prescribed was nonselective beta-blockers (39.36%) followed by calcium channel blockers (16.51%). The status in terms of cost utilized average per unit was the highest for telmisartan (3.371 (0.90) SR (USD)). The propranolol was most cost-effective (average cost per unit 1.43 (0.38) SR) in relative to the other antihypertensive prescribed.

Conclusion

Our study suggested that the prescription pattern of drugs used for the treatment of hypertension adhered with the JNC 8 guidelines. Monotherapy was reliably more recommended in the initial stages of hypertension. Higher percentage of patients (78.32%) was found to be on monotherapy. The Saudi Food and Drug Authority (SFDA) has overwhelmed for fixation of prices of drugs.

Health expenditure and health services utilization comparison of patients with type 2 diabetes on sodium–glucose cotransporter‐2 inhibitors versus dipeptidyl peptidase‐4 inhibitors: evidence from 2015 to 2016 medical expenditure panel survey

Pranav M. Patel, Varun Vaidya — Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objectives

Primary objective of this study was to compare the overall health expenditures of patients with type 2 diabetes on sodium–glucose cotransporter-2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP4) inhibitors.

Methods

Two cohorts of type 2 diabetes patients receiving either SGLT2 inhibitor with metformin or DPP4 inhibitor with metformin were identified from 2015 to 2016 Medical Expenditure Panel Survey (MEPS) data. Propensity score matching was used to balance cohorts based on socio-economic status, insulin utilization status, and the Charlson comorbidity score. Patients in SGLT2 inhibitor cohort were matched with patients in DPP4 inhibitor cohort using 1 : 2 ratio on the logit of propensity score using caliper width of 0.1 of the standard deviation of the logit of the propensity score. Expenditure variables were analysed using a generalized linear model with log link function and gamma distribution and adjusted for socio-economic variables. Unadjusted means were obtained using bootstrap.

Results

After propensity score matching, 240 patients were left in the sample with 80 patients in SGLT2 inhibitor cohort and 160 patients in DPP4 inhibitor cohort. Unadjusted average annual total health expenditure was significantly higher in the SGLT2 inhibitor cohort versus DPP4 inhibitor cohort ($17,325 versus $15,702; P value <0.0001). After adjusting for socio-economic factors, overall health expenditure (β = −0.3516; P = 0.0038) was significantly lower in DPP4 inhibitor cohort compared to SGLT2 inhibitor.

Conclusion

SGLT2 inhibitors were associated with significantly higher overall and prescription expenditures compared to DPP4 inhibitors during the study period evaluated. Future studies need to utilize administrative claims data to assess current comparativeness effectiveness trends.

Influences on interactions between physicians in the public and private sectors and medical representatives in Yemen

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objective

This study aims to assess the relative importance of attitude and subjective norms as well as physicians' characteristics and practice-setting factors in predicting the outcome of physicians' interactions with MRs.

Methods

A cross-sectional survey was conducted among a convenience sample of 602 physicians in Sana'a, Yemen. The data were analysed using descriptive and inferential analyses. The t-test/Mann–Whitney test and ANOVA/Kruskal–Wallis test with post hoc analysis, principal component analysis, correlation analysis and regression analysis were applied at an a priori significance level of 0.05.

Key findings

The response rate was 76.5%. Results showed that physicians who see a greater number of MRs per week or have academic affiliations were significantly more likely to have received high/low-value promotional items than were those who saw fewer MRs or have no academic affiliations (P values < 0.001 and 0.021, respectively). Also male physicians and physicians who have private clinics were significantly more likely to have received high-value promotional items (P value < 0.001). Three out of five hypotheses were supported (physicians' belief in the appropriateness of accepting high/low-value pharmaceutical companies' promotional techniques relate positively and significantly to their behaviour of interactions with MRs, and physicians' attitudes towards pharmaceutical companies relates positively and significantly to their interactions with MRs).

Conclusion

Physicians in Yemen consider most of the promotional techniques as normal practice. The article provides empirical evidence for policymakers in developing countries in general, and Yemen specifically, to develop suitable policies and regulations for drug promotion.

Assessing trends in medical expenditures and measuring the impact of health‐related quality of life on medical expenditures for U.S. adults with diabetes associated chronic kidney disease using 2002–2016 medical expenditure panel survey data

Aditi A. Kharat, Jagannath Muzumdar, Monica Hwang, Wenchen Wu — Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Background

Chronic Kidney Disease (CKD) is one of the most expensive comorbidities of diabetes. The changes in medical expenditures over the years and the latest economic burden of CKD among diabetes are unknown.

Objectives

(1) To examine the trend and estimate the differences in medical expenditures between adults with diabetes-associated CKD and diabetes-no CKD from 2002 to 2016 using Medical Expenditure Panel Survey data (2) To study the impact of health-related quality of life (HRQOL) on medical expenditure for adults with diabetes-associated CKD.

Methods

This is a retrospective cross-sectional study. Descriptive statistics were used for studying the trend in medical expenditures from 2002 to 2016. HRQOL was measured using physical and mental component summary (PCS, MCS). Two-part model was utilized for estimating the incremental medical expenditure for diabetes patients by CKD status.

Key findings

A total of 35,112 diabetic adults were identified in the Medical Expenditure Panel Survey dataset. Among these, 3,489 individuals had CKD. The pooled mean expenditure for diabetes-associated CKD was $25,953 which was almost double of $12,170 for patients with diabetes and no CKD. Individuals with diabetes CKD had $12,109 higher adjusted direct incremental medical expenditure as compared to diabetes-no CKD. With respect to HRQOL, individuals in the highest quartile of PCS and MCS spent $18,076 and $10,307 lesser than those in the lowest quartile respectively.

Conclusions

Medical expenditures associated with CKD are a significant contributor to the financial burden among diabetes adults. Improvements in HRQOL also lead to lower healthcare costs in diabetes-associated CKD patients.

Use and non‐use of a nationwide patient portal – a survey among pharmacy customers

Maria Sääskilahti, Emma Aarnio, Elina Lämsä, Riitta Ahonen, Johanna Timonen — Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objectives

A nationwide patient portal (My Kanta) for viewing electronic prescriptions and health data has been phased in since 2010 in Finland. This study aimed to study how commonly Finnish pharmacy customers use My Kanta, the factors related to My Kanta use, the main reasons for non-use and how non-users would like to monitor their medication and health information.

Methods

A survey was conducted among adult pharmacy customers purchasing prescription medicines for themselves or for their child <18 years. Questionnaires (N = 2866) were distributed from 18 pharmacies across Finland. Open-ended questions were analysed qualitatively. Quantitative analyses included frequencies, Chi-square tests, Fisher's exact tests, t-tests and logistic regression analysis.

Key findings

In total, 994 (34.7%) questionnaires were included. Most (82.5%) adult pharmacy customers used My Kanta. Use of the service was associated with use of the internet to search for health-related information (OR: 8.82, 95% CI: 4.65‒16.74), active internet use (OR: 7.30, 95 %: CI 3.54‒15.08), living in Northern (OR: 4.35, 95% CI: 1.75‒10.82) or Eastern (OR: 3.25, 95% CI: 1.41‒7.48) parts of Finland, and the increasing number of currently used regular prescription medicines (OR: 1.16, 95% CI: 1.01‒1.34). The main reasons for non-use were lack of need and tools. Non-users reported physician/health centres and pharmacies as their preferred sources of medication and health information.

Conclusions

Most Finnish pharmacy customers use the My Kanta nationwide patient portal. The strongest predictors for use are factors related to internet use. Some pharmacy customers do not use My Kanta despite having the necessary means. The main reason for non-use is a lack of need. Customers unable to use My Kanta want to monitor their medication and health information via healthcare professionals.

A retrospective study on prescribing pattern and cost analysis of proton‐pump inhibitors used among adults of Saudi Arabia

Mohammad Daud Ali, Ayaz Ahmad — Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objective

To evaluate the use of proton-pump inhibitors (PPIs) for treatment of different gastric disease in Saudi population and their related administration cost.

Materials and methods

It was a cross-sectional retrospective drug utilization study. The utilization rates and cost analysis of each PPIs class of drugs were compared. Study data were obtained from pharmacy database. Data between 1 January 2019 and 31 December 2019 were investigated, including incidence, prevalence and duration of use of proton-pump inhibitors among adults of Saudi Arabia.

Key findings

We observed 26 798 (4.27%) prescription of PPIs were dispensed in the in-patient and out-patient pharmacy department of Al-Mana Group of Hospital (AGH) Al khobar. Among all the PPIs user, more than the half ((53.01%, n = 14 208), 95% CI (52.42–53.62)) were male. 30–40 years age patients (24.57%, 95% CI (24.06–25.09) (n = 6585)) were highest number of PPI users. Nearly, equal number of PPI users belongs between 51–60 years ((20.88%, n = 5596), 95% CI (20.40–21.37)) and >60 years ((20.36%, n = 5456), 95% CI (19.8–20.85)). Among all the dispensed PPIs drugs, Pantoprazole is dispensed to the highest number of patients (79.09% (95% CI, 78.61–79.58) (n = 21 197)) while their average duration of therapy was 18.86 days. Among all PPIs, pantoprazole average unit wise cost was highest SR 8.83 (USD 2.35) in comparison to other PPIs.

Conclusion

In our study, among all the PPIs Pantoprazole was prescribed to the highest number of patients also it was costliest; hence, their safe and effective use must be warranted. Current study will also help in to develop nation database regarding utilization of proton-pump inhibitors.

Assessment of medication knowledge among patients with asthma

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objectives

Asthmatic patient's knowledge about their treatment can affect asthma control and adherence level. This study investigated the level of medication knowledge, the level of adherence and factors affecting both knowledge and adherence in adult patients with asthma.

Methods

A cross-sectional study was carried out in Jordan between 2017 and 2018. A face-to-face interview was conducted by a clinical pharmacist with asthma patients attending hospital pharmacies for refilling their prescriptions.

Key findings

A total of 218 adults with asthma were included into the study and 60.6% were knowledgeable about their medications. University degree education (OR = 3.67; P value < 0.001), positive family history of asthma (OR = 1.89; P value = 0.04) and longer asthma duration (OR = 1.03; P value = 0.049) were significantly associated with a high medication knowledge. On the other hand, married participants were less knowledgeable than single ones (OR = 0.30; P value = 0.041). High medication knowledge score (OR = 4.76, P value = 0.008), older age (OR = 1.06, P value = 0.004) and male gender (OR = 3.82, P value = 0.01) were significant predictors of high medication adherence.

Conclusions

These findings highlight the importance of educational programmes that should be conducted in primary healthcare settings, such as community pharmacies, where pharmacists should educate patients about their medication and the importance of adherence.

Healthcare professionals’ knowledge, perception and practice towards COVID‐19: A cross‐sectional web‐survey

Mohammed I. Aladul, Harith Kh. Al‐Qazaz, Omer Q. B. Allela — Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objective

COVID-19 is a highly contagious disease. Healthcare professionals (HCPs) are increasingly facing suspected and confirmed cases of COVID-19. To evaluate Iraqi HCPs (physicians, dentists and pharmacists) knowledge, perception and practice towards COVID-19.

Methods

This was a cross-sectional, anonymised web-survey, using an electronic application (Surveyheart^®). The web-survey link was posted via the closed groups of physicians, dentists and pharmacists in Iraq on Facebook and Twitter. The questionnaire was self-administered and data was collected between, 10th–25th of March 2020.

Key findings

Three hundred seventy two HCPs participated in the study. The majority of Iraqi HCPs have a good knowledge about the origin, incubation period, the mode of transmission, the common signs and symptoms and the groups of patients who were at higher risk of COVID-19. HCPs identified internet, social media as the main source of information about the disease. The lowest rate of correct answers was found in items related to the virus which is responsible for the development of COVID-19 disease (44.6%) and the types of face mask that protect against COVID-19 (40.6%). Physicians were found to have higher score of knowledge compared to dentists and pharmacists. Iraqi HCPs requested more strict preventive measure to be applied to prevent the spread of the disease. Iraqi HCPs expressed their inclination to use the international guidelines to treat confirmed cases.

Conclusions

Iraqi HCPs have an overall good knowledge towards COVID-19. More information should be published from reputable and authentic sources to HCPs. The Ministry of Health in Iraq could take its responsibility to inform the health providers with updated and confirmed information about COVID-19 prevention and management.

Investigating prescribing errors in the emergency department of a large governmental hospital in Jordan

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Background

Although prescribing errors (PEs) are the most common type of medication errors and cause morbidity and mortality, they have been rarely studied.

Objective

The study aimed to investigate PEs incidence, types, severity, causes, predictors, pharmacists' interventions accepted by doctors and computer-related errors.

Setting

This study was conducted in the emergency department of the largest governmental hospital in Jordan.

Method

This was a retrospective observational 4-week study. A validated definition of PEs was adopted, and errors were identified by direct observation of all prescriptions. Structured interviews with doctors to assess the causes of errors were conducted within three days of the prescription date; the severity of PEs was rated by a committee.

Main outcome measure

Prescribing errors incidence, types, severity, causes, predictors, pharmacists' interventions accepted by doctors and computer-related errors.

Results

For 1330 patients, 3470 medication orders were recorded. Almost one in five patients had PEs (n = 288, 21.65%), and the total number of medication orders for patients who had errors was 610. The PEs incidence was 12.5% (95% CI 11.4%–3.5% (n = 450/3597)). Analgesics were the most common medications associated with PEs (232/610, 38.03%). The top two types of PEs detected were wrong drug (165/450, 36.6%) and wrong dose (142/450, 31.5%) respectively. Most PEs were clinically significant errors (342/450, 76%). Doctors refused pharmacists' interventions on their orders in 132 (45.8%) prescriptions. The most common cause of errors was poor skills of doctors in electronic prescribing system (266/450, 59%). Predictors of PEs were the following: drug with multiple dosage forms (OR 2.998; 95% CI 1.41–6.34; P = 0.004) and a prescription with polypharmacy (OR 1.685; 95% CI 1.25%–2.26%; P = 0.001).

Conclusion

A national approach for observing, intervening on and correcting PEs is necessary to improve patient safety.

Complexities in pharmaceutical health services research

Albert I. Wertheimer — Mon, 09 Nov 2020 03:25:58 -0800

Journal of Pharmaceutical Health Services Research, Volume 11, Issue 4, Page 305-305, November 2020.

Issue Information

Mon, 09 Nov 2020 03:25:58 -0800

Journal of Pharmaceutical Health Services Research, Volume 11, Issue 4, Page 303-304, November 2020.

Why healthcare market needs government intervention to improve access to essential medicines and healthcare efficiency: a scoping review from pharmaceutical price regulation perspective

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Background

Access to quality essential medicines at affordable price to patients in the healthcare market is one of the main goals of universal health coverage and health-related sustainable development goals. Healthcare market is imperfect, and the government cannot ensure access to essential medicines if the market is left to operate under invisible hand control. This scoping review was conducted with intention to provide the clear picture on impact of pharmaceutical price regulation on access to essential medicines, drug innovation and launching.

Methods

We searched articles written in the English language since January 2000 from PubMed, Embase, Scopus, Ovid/Medline and Google scholar with systematic search query.

Results

Access to essential medicines, which is defined in terms of availability, affordability, accessibility, acceptability and quality of drugs, can be improved by pharmaceutical price regulation. Countries can use different price regulation strategies based on their healthcare objectives and priority healthcare needs. Country-specific pharmaceutical price regulation could not significantly affect drug innovation and launching. However, supportive strategies such as open public funding for drug innovation research, providing innovation awards and strong patent rights can counterbalance the effect of price regulation on innovation and drug development research in developed countries.

Conclusion

Regulating pharmaceutical pricing system is one of the key strategies to ensure access to essential medicines. Countries that have implemented pharmaceutical price regulation system (Germany, the UK, Canada and Iran) have achieved better access to essential medicines. However, the US and Ethiopian health systems that are unregulated concerning pharmaceutical pricing had a great challenge of affordability of essential medicines. Therefore, setting country-specific pharmaceutical price regulation system along with additional strategies to improve drug innovation is critical to ensure access to essential medicines.

Cost‐effectiveness of Interventional therapies for management of Treatment‐resistant hypertension: systematic review of pharmacoeconomic studies

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Background

Treatment resistant hypertension (TRH) is defined as uncontrolled blood pressure (>140/90 mm Hg) after treatment with the intensified dose of three standard antihypertensive drugs. Management of TRH involves addition of fourth line drugs on standard care or interventional therapies (Renal denervation, Baroreceptor activation, Central venous anastomosis). However, evidence concerning cost-effectiveness of interventional therapies is inconclusive. Objective: This systematic review was conducted to extract the level of evidence on cost-effectiveness of interventional therapies for TRH.

Method

We systematically searched articles written in English language since January 2000 to January 2020 from the following databases: PubMed/Medline, Ovid/Medline, Embase, Scopus, Web of Science, Google scholar and other relevant sources.

Key findings

Twelve pharmacoeconomic studies were included in this systematic review. Renal denervation (RDN) is the most commonly studied intervention therapy for treatment of TRH. Participants included in the study vary from age 18-99 years. The incremental cost-effectiveness ratio (ICER) of RDN ranged from $1,709.84 per QALY gained in Netherlands to 66,380.3 per QALY gained in Australia. RDN was cost-effective in high-risk patients in UK, Australia, Canada, Netherlands, USA, Germany, Russia and Korea. The cost-effectiveness was influenced by the magnitude of effect of RDN on systolic blood pressure, the rate of RDN nonresponders, and the procedure costs of RDN and assumption of long-term time horizon. However, the ICER of RDN in Mexico was above MXN$ 139,000 GDP/capita of the country. The ICER of implantable carotid body stimulator was $64,400 per QALYs gained. The cost-effectiveness of baroreceptor activation didn’t improve with age.

Conclusion

Overall cost-effectiveness of interventional therapies for treatment of TRH was inconclusive based on the current available evidence. Therefore, strong clinical trials and pharmacoeconomic evaluations from different perspectives in various candidate populations are needed to generate adequate clinical and cost-effectiveness evidence for using interventional therapies in treatment of treatment resistant hypertension.

Factors associated with the level of knowledge about hypertension in Malaysia: A short communication

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objective

The aim of this study was to identify factors that have a correlation with hypertensive patients’ knowledge in Malaysia.

Methods

A cross-sectional survey and face-to-face interview methods were applied, and 1000 Malaysian adults were recruited to be involved in this study. The study was carried out in Hospital Kuala Lumpur, and self-administered questionnaire was adopted from previous literature study.

Key findings

Most respondents were female, and the mean age was 48 years old. Analytical test showed that there is an association between gender, age, race, location, education level, and source of information and their knowledge about hypertension. The odds of knowledge were higher among female, urban, higher level of education, young (≤50 years old), and Chinese and Malay respondents and those who got their information from health professionals.

Conclusions

There are several factors have a great impact on hypertension knowledge in Malaysia; hence, understanding them makes it possible for the community to change public policies and educational programmes for the population that need it the most.

Critical Appraisal of the Clinical Practice Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk: European Society of Cardiology (ESC) and European Atherosclerosis Society (ESC/EAS) 2019 Guidelines

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objective

The aim of the study was to assess the quality of the recently published European clinical practice guidelines for the management of dyslipidaemias, utilizing the refined Appraisal of Guidelines for Research & Evaluation tool.

Method

The 2019 European Society of Cardiology and European Atherosclerosis Society Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk was appraised and scored for methodological rigour and transparency by 5 independent appraisers using a validated tool.

Key findings

The guideline scored highest in the domains that evaluated editorial independence (100%) and clarity of presentation (98.6%) and lowest in the domains that addressed stakeholder involvement (55.56%) and rigour of development (63%). Overall the quality of the guideline was high, and all reviewers recommended its use in practice.

Conclusion

The guideline’s overall quality was judged to be high, and all appraisers recommended its use in practice without modifications.

Barriers and facilitators to provision of written consumer medicines information among community pharmacists in Malaysia: a cross‐sectional study

Omotayo Fatokun, Xin Yi Mooi, Osama Helweh, Mogana Rajagopal — Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objectives

This study examined the barriers and facilitators to the provision of consumer medication information leaflets (CMIL) by community pharmacists in Malaysia and assessed the relationship between the participants' characteristics and provision of CMIL.

Methods

This was a cross-sectional self-administered questionnaire survey conducted among pharmacists working in randomly selected community pharmacies in the Federal Territories of Kuala Lumpur and Putrajaya, and the State of Selangor, Malaysia. Multiple response analysis was conducted to examine the barriers and facilitators. Chi-square test was used to assess the relationship between the participants' characteristics and provision of CMIL. IBM SPSS Statistics version 23 software was used for all statistical analysis. Statistical significance was set at P < 0.05.

Key findings

A total of 162 participants were involved in the study. Response rate was 77.5% (162 out of 209) and completion rate 100%. The two most frequently reported barriers to non-provision of CMIL were because the customer has taken the medicine previously (29.4%) and the customer receives all the information they need verbally (20.0%). The two most frequently reported facilitators to the provision of CMIL were because the community pharmacists felt they have a duty of care to inform the customer about their medicine (16.3%) and the customer has a right to information about their medicine (15.6%). There was a significant association between the provision of CMIL and participants educational level (P = 0.005) and awareness of CMIL (P < 0.001).

Conclusions

The key barriers to the provision of CMIL by the community pharmacists appeared to be related to attitudinal factors, while key facilitators appeared to be related to the professional obligations of the community pharmacists. Increased awareness and educational strategies would be important in improving the provision of CMIL by community pharmacists in Malaysia.

Anticoagulant drug utilization pattern and their cost analysis: a retrospective study from Saudi Arabia

Mon, 09 Nov 2020 03:25:58 -0800

Abstract

Objective

The study was aimed to evaluate the cost and drug utilization pattern of anticoagulant drugs in a clinical setting in Saudi Arabia.

Method

A cross-sectional retrospective study was conducted in a private hospital in Saudi Arabia. World Health Organization, defined daily dose, and American Society of Hematology methods were used to compute the daily price of each anticoagulant agent.

Key findings

Consumption of oral anticoagulants was very less as compared to the parenteral. Apixaban was the most prescribed oral drug, while enoxaparin sodium was the drug of choice among the parenteral. In oral anticoagulants, the unit-wise cost was found to be highest for Rivaroxaban (12.60 SR (3.36 USD) and less for Warfarin (0.82 SR (0.22 USD)). Heparin sodium cost (51.62 SR (13.76 USD) was found to be the most expensive parenteral agent while the least expensive was Phytomenadione (3.76 SR (1.00 USD)).

Conclusion

Apixaban was the preferred oral anticoagulant among all the studied anticoagulants, although Warfarin is the cheapest. Therapeutic drug monitoring was recommended for Warfarin. The study highlights the importance of more studies to measure the advantages and disadvantages of all types of anticoagulants.