Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 9 Articles
Background\r\nThe majority of retirement village residents are at risk of medication misadventure. In a recent survey of retirement village residents in Victoria, two-thirds had at least one medication-related risk factor, and hence were eligible to receive a government-subsidised Home Medicines Review (HMR). However, only 6% of eligible residents had received a HMR in the previous 12 months. Reasons for the poor uptake of HMR, and interventions for improving HMR uptake, have been identified and developed with input from stakeholders. The trial will test the effect of Pharmacist-conducted HMR to Address the Risk of Medication-related Events in Retirement Villages (PHARMER) in improving the uptake of HMRs among retirement village residents.\r\nMethods/Design\r\nThis is a multicentre prospective cluster randomised controlled trial. Ten retirement villages in Victoria, Australia will be recruited for this trial. Retirement villages will be selected in consultation with the Residents of Retirement Villages Victoria Inc. (RRVV), based on geographical locations (e.g. northeast or southwest), size and other factors. Residents from selected villages will be recruited with the help of RRVV Resident Liaison Officers using a range of strategies. Randomisation will be by geographical location to minimise contamination. Participating villages and residents will be allocated to either Pharmacist Intervention Group (PIG) or Usual Care Group (UCG). Each group will include five retirement villages and will have at least 77 residents in total. The intervention (PHARMER) comprises educating residents regarding HMR, and using a risk assessment checklist by residents to notify their General Practitioners of their medication risk. Uptake of HMR and medication adherence will be assessed in both PIG and UCG at three and six months using telephone interviews and questionnaires.\r\nDiscussion\r\nThis study is the first to develop and test an intervention to improve the uptake of HMR among Australian residents in retirement villages, with a view to decreasing medication risk. A multi-faceted interventional approach will be used as suggested by stakeholders. The trial is expected to be complete by late 2011 and results will be available in 2012....
Non-prescription or over the counter (OTC) medicines can be defined as those which are used for self medication and can be available from pharmacies without a doctor’s prescription. These products usually have many years often decades of experience of safe usage & are used in a large number of countries around the world so these products do not need to be subject to the same extent of regulation as new prescription medicines at the point of registration or in ongoing usage. The substantial knowledge built up under prescription conditions of a medicine’s quality, safety and efficacy profile can be carried over to nonprescription use. The review describes the existing regulations for non prescription drugs in regulated countries like USA, EU, Australia and available regulations for the non prescription drugs in India. Information was collected from legislation, guidance and official documents published by concerned regulatory authorities like USFDA (United States Food and Drugs Administration) in the US, EMEA (European Medicines Evaluation Agency)for European Union, TGA (Therapeutic Goods Administration) for Australia and CDSCO (Central Drugs Standard Control Organization) for India. A comparison made to understand the regulations for registration, marketing & labeling revealed that the OTC regulations vary from country to country....
Vildagliptin is a potent and selective inhibitor of Dipeptidyl Peptidase-IV (DPP-4), orally active, that improves glycemic control in patients with type 2 diabetes (T2DM) primarily by enhancing pancreatic (α and β) islet function. Vildagliptin reduces HbA1c when given as monotherapy, without weight gain and with minimal hypoglycemia, or in combination with the most commonly prescribed classes of oral hypoglycemic drugs. In this study comparison of efficacy and safety of vildagliptin versus Glimepiride and Metformin in Type 2 Diabetes mellitus were carried out. Plasma glucose levels were measured at baseline and study end point (12 weeks) in a trial evaluating add-on therapy to metformin with 50 mg vildagliptin od and Glimepiride up to 4 mg compared with Glimepiride up to 6 mg in Type 2 Diabetes. Glycosylated haemoglobin (A1C), Fasting Plasma Glucose (FPG) and Post prandial glucose (PPG) were reduced similarly in both groups. Hypoglycaemic events were less in both the groups. Combination of Vildagliptin to Glimepiride and metformin therapy improved A1C, fasting and postprandial glucose levels without hypoglycaemia....
Background\r\nBangladesh suffers from a lack of healthcare providers. The growing chronic disease epidemic's demand for healthcare resources will further strain Bangladesh's limited healthcare workforce. Little is known about how Bangladeshis with chronic disease seek care. This study describes chronic disease patients' care seeking behavior by analyzing which providers diagnose these diseases.\r\nMethods\r\nDuring 2 month periods in 2009, a cross-sectional survey collected descriptive data on chronic disease diagnoses among 3 surveillance populations within the International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B) network. The maximum number of respondents (over age 25) who reported having ever been diagnosed with a chronic disease determined the sample size. Using SAS software (version 8.0) multivariate regression analyses were preformed on related sociodemographic factors.\r\nResults\r\nOf the 32,665 survey respondents, 8,591 self reported having a chronic disease. Chronically ill respondents were 63.4% rural residents. Hypertension was the most prevalent disease in rural (12.4%) and urban (16.1%) areas. In rural areas chronic disease diagnoses were made by MBBS doctors (59.7%) and Informal Allopathic Providers (IAPs) (34.9%). In urban areas chronic disease diagnoses were made by MBBS doctors (88.0%) and IAP (7.9%). Our analysis identified several groups that depended heavily on IAP for coverage, particularly rural, poor and women.\r\nConclusion\r\nIAPs play important roles in chronic disease care, particularly in rural areas. Input and cooperation from IAPs are needed to minimize rural health disparities. More research on IAP knowledge and practices regarding chronic disease is needed to properly utilize this potential healthcare resource....
Background\r\nResearches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions.\r\nMethods\r\nThis cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itabora� (ITA), Ribeir�£o Preto (RP) and S�£o Jos�© do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the Primary Care Assessment Tool adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites.\r\nResults\r\n\"Access to treatment\" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. \"Bond\" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. \"Range of services\" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. \"Coordination\" was evaluated as satisfactory in all cities. \"Family focus\" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP.\r\nConclusions\r\nTwo types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment....
Background\r\nPatients' non-adherence to drug therapy is a major problem for society as it is associated with reduced health outcomes. Generally, approximately only 50% of patients with chronic disease in developed countries adhere to prescribed therapy, and the most common non-adherence refers to chronic under-use, i.e. patients use less medication than prescribed or prematurely stop the therapy. Patients' non-adherence leads to high additional costs for society in terms of poor health. Non-adherence is also related to the unnecessary sale of drugs. The aim of the present study was to estimate the drug acquisition cost related to non-adherence to drug therapy in a national population.\r\nMethods\r\nWe constructed a model of the drug acquisition cost related to non-adherence to drug therapy based on patient register data of dispensed out-patient prescriptions in the entire Swedish population during a 12-month period. In the model, the total drug acquisition cost was successively adjusted for the assumed different rates of primary non-adherence (prescriptions not being filled by the patient), and secondary non-adherence (medication not being taken as prescribed) according to the patient's age, therapies, and the number of dispensed drugs per patient.\r\n\r\nResults\r\nWith an assumption of a general primary non-adherence rate of 3%, and a general secondary non-adherence rate of 50%, for all types of drugs, the acquisition cost related to non-adherence totalled SEK 11.2 billion (ââ??¬ 1.2 billion), or 48.5% of total drug acquisition costs in Sweden 2006.\r\n\r\nWith the assumption of varying primary non-adherence rates for different age groups and different secondary non-adherence rates for varying types of drug therapies, the acquisition cost related to non-adherence totalled SEK 9.3 billion (ââ??¬ 1.0 billion), or 40.2% of the total drug acquisition costs.\r\nWhen the assumption of varying primary and secondary non-adherence rates for a different number of dispensed drugs per patient was added to the model, the acquisition cost related to non-adherence totalled SEK 9.9 billion (ââ??¬ 1.1 billion), or 42.6% of the total drug acquisition costs.\r\nConclusions\r\nOur estimate indicates that drug acquisition costs related to non-adherence represent a substantial proportion of the economic resources in the health care sector. A low rate of primary non-adherence, combined with a high rate of secondary non-adherence, contributes to a large degree of unnecessary medical spending. Thus, efforts of different types of interventions are needed to improve secondary adherence....
Background\r\nRecent investigations by the Ministry of Health of Cambodia suggest that counterfeit medicines have been introduced into the pharmaceutical market in tampered packaging. To further explore this possibility, an interview survey was conducted at the wholesaler level to investigate the medicinal supply chain in Cambodia.\r\nMethods\r\nManaging executives of 62 (83.8%) registered wholesalers of modern medicines in Cambodia were interviewed in 2009 on their knowledge of, perception on, and practices related to counterfeiting issues through a semi-structured questionnaire.\r\nResults\r\nAccording to our findings, 12.9% of the wholesalers had encountered counterfeit medicine. However, they demonstrated a variety of perceptions regarding this issue. A majority (59.7%) defined counterfeit medicines as medicines without registration, while other definitions included medicines that were fraudulently manufactured, medicines without a batch/lot number, those containing harmful ingredients or a reduced amount of active ingredients, and expired medicines. Additionally, 8.1% responded that they did not know what counterfeit medicines were.\r\n\r\nDuring procurement, 66.1% of the wholesalers consider whether the product is registered in Cambodia, while 64.5% consider the credibility and quality of the products and 61.3% consider the reputation of the manufacturers. When receiving a consignment, 80.6% of wholesalers check the intactness of medicines, 72.6% check the specification and amount of medicines, 71% check Cambodian registration, 56.5% check that the packaging is intact, 54.8% check batch and lot numbers, 48.4% check the dates of manufacture and expiration, and 9.7% check analytical certificates.\r\nOut of 62 wholesalers, 14.5% had received medicines that arrived without packages or were separated from their packaging and had to be repacked before distribution. Significant statistical association was found between wholesalers who received medicines separately from their packs/containers and who consider their belief on reliability of pharmaceutical products of certain manufacturing country during procurement (Chi-square: 12.951, P = 0.002). When wholesalers divide medicines from larger packs into smaller ones, 54.8% use packaging purchased from local markets.\r\nConclusion\r\nA number of wholesalers think counterfeit medicines are medicines without registration, and/or do not have any uniform ideas on the issue and what to do, when they find or suspect counterfeits. Furthermore, their strict adherence to anti-counterfeiting measures is urgently needed....
Background\r\nDirect-to-consumer (DTC) marketing of pharmaceuticals is controversial, yet effective. Little is known relating patterns of medication use to patient responsiveness to DTC.\r\nMethods\r\nWe conducted a secondary analysis of data collected in national telephone survey on knowledge of and attitudes toward DTC advertisements. The survey of 1081 U.S. adults (response rate = 65%) was conducted by the Food and Drug Administration (FDA). Responsiveness to DTC was defined as an affirmative response to the item: \"Has an advertisement for a prescription drug ever caused you to ask a doctor about a medical condition or illness of your own that you had not talked to a doctor about before?\" Patients reported number of prescription and over-the-counter (OTC) medicines taken as well as demographic and personal health information.\r\nResults\r\nOf 771 respondents who met study criteria, 195 (25%) were responsive to DTC. Only 7% respondents taking no prescription were responsive, whereas 45% of respondents taking 5 or more prescription medications were responsive. This trend remained significant (p trend .0009) even when controlling for age, gender, race, educational attainment, income, self-reported health status, and whether respondents \"liked\" DTC advertising. There was no relationship between the number of OTC medications taken and the propensity to discuss health-related problems in response to DTC advertisements (p = .4).\r\nConclusion\r\nThere is a strong cross-sectional relationship between the number of prescription, but not OTC, drugs used and responsiveness to DTC advertising. Although this relationship could be explained by physician compliance with patient requests for medications, it is also plausible that DTC advertisements have a particular appeal to patients prone to taking multiple medications. Outpatients motivated to discuss medical conditions based on their exposure to DTC advertising may require a careful medication history to evaluate for therapeutic duplication or overmedication....
Tretinoin or all- trans retinoic acid, even known as Vitamin A acid, is a widely used drug in the topical treatment of acne, photoaged skin, psoriasis and other skin related disorders. Stultgen and Beer reported first use of tretinoin in the treatment of keratolytic disorders in 1962. Early application of topical retinoids offers numerous advantages of being comedolytic as well as decreasing the cell turnover and the cell cohesion. It induces the proliferation of the follicular epithelium and normalization of acro-fundibular keratinization leading to good therapeutic results in upto 90% of acne patients. Topical retinoids particularly tretinoin have a well-documented ability to repair photoaged skin at clinical, histological and molecular level. The use of topical retinoids may actually prevent photoageing. Psoriasis is a major skin disease recognized for centuries and as there is no cure, a variety of therapeutic moieties are available to reduce the severity and increase the life quality of the patient. Retinoids may have a direct effect on growth and differentiation of keratinising and non- keratinizing epithelium. Tretinoin also finds application in the treatment of lentigenes, mottled hyperpigmentation, wound healing and cutaneous malignancies....
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