scholarly journals Community pharmacies, drug stores, and antibiotic dispensing in Indonesia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Astri Ferdiana ◽  
Marco Liverani ◽  
Mishal Khan ◽  
Luh Putu Lila Wulandari ◽  
Yusuf Ari Mashuri ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Financial Incentives ◽  
Market Competition ◽  
Essential Medicines ◽  
Careful Examination ◽  
Policy Outcomes ◽  
Community Pharmacies ◽  
Unintended Effects ◽  
Self Medication ◽  
Dispensing Practices

Abstract Background Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. Methods In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. Results A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement. Conclusions Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.

scholarly journals Community Pharmacies, Drug Stores, and Antibiotic Dispensing in Indonesia: A Qualitative Study

2021 ◽  
Author(s):  
Astri Ferdiana ◽  
Marco Liverani ◽  
Mishal Khan ◽  
Luh Putu Lila Wulandari ◽  
Yusuf Ari Mashuri ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Financial Incentives ◽  
Access To Medicines ◽  
Careful Examination ◽  
Community Pharmacies ◽  
Unintended Effects ◽  
Policy Reforms ◽  
Self Medication ◽  
Middle Income ◽  
Dispensing Practices

Abstract Background Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. Methods In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 60 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 29), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. Results A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR driving patient demand, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms, and weak regulatory enforcement. Conclusions Inappropriate dispensing of antibiotics in community pharmacies is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. Concerted action should be taken to address this complexity and involve such providers in the development and implementation of AMR national action plans.

scholarly journals Prevalence of drug-related problems in self-medication in Danish community pharmacies

2012 ◽  
Vol 3 (4) ◽  
Author(s):  
Bente Frøkjær ◽  
Tina Bolvig ◽  
Nina Griese ◽  
Hanne Herborg ◽  
Charlotte Rossing
Keyword(s):  
Original Research ◽  
Community Pharmacies ◽  
Unintended Effects ◽  
Drug Related Problems ◽  
Pharmacy Staff ◽  
Self Medication ◽  
Over The Counter ◽  
Professional Advice ◽  
Presenting Symptoms ◽  
Otc Medicines

Background: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this. Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine) identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems. Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies. Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC) medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs) were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines. Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner. Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect, unintended effects and, to a lesser extent, inappropriate self-medication.   Type: Original Research

scholarly journals Public perception of community pharmacists in South Africa: a preliminary study

2006 ◽  
Vol 11 (3) ◽  
Author(s):  
Suzanne Bornman ◽  
Ilse Truter ◽  
Daniel JL Venter
Keyword(s):  
South Africa ◽  
Full Text ◽  
Public Perception ◽  
Community Pharmacists ◽  
Community Pharmacies ◽  
Self Medication ◽  
Over The Counter ◽  
Preliminary Study

This survey forms part of a study undertaken to identify and quantify the community pharmacist’s involvement in the use of non-prescription/over-the-counter (OTC) medicine/self-medication in community pharmacies throughout South Africa. Opsomming Hierdie opname vorm deel van ‘n studie wat onderneem word om die gemeenskapsapteker se betrokkenheid in die gebruik van nie-voorskrif/oor-die-toonbank medikasie/ selfmedikasie in gemeenskapsapteke in Suid Afrika te identifiseer en te kwantifiseer. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Women’s attitude toward gynecological pain in fertile age: Results from a cross-sectional study among Italian community pharmacies

2018 ◽  
Vol 10 (2) ◽  
pp. 88-94
Author(s):  
Corrado Giua Marassi ◽  
Assunta Pistone ◽  
Fabio Parazzini ◽  
Silvia Vannuccini ◽  
Felice Petraglia
Keyword(s):  
Medical Treatment ◽  
Pelvic Pain ◽  
Epidemiological Data ◽  
Cross Sectional Study ◽  
Community Pharmacies ◽  
Sectional Study ◽  
Self Medication ◽  
Cross Sectional ◽  
Mean Delay ◽  
Italian Community

Introduction: Several epidemiological data on women afferent to clinics for medical treatment of pelvic pain are available, while few studies explored the general population. Thus, this study aimed to investigate women presenting with gynecological pain at the community pharmacy and to evaluate the relevance of pharmacist advice regarding medical treatment. Methods: A cross-sectional study was conducted in a sample of 10 Italian community pharmacies, by administering a structured questionnaire to fertile age women reporting pelvic pain during the last 3 months. Questions were concerning demographic information, pain characteristics, women’s behavior toward gynecological pain, and diagnosis possibly received from a physician. Results: A group of 290 women were interviewed. Severe pain was reported in 58.3%, with a mean ± SD of 4.4 ± 6.8 days of suffering, causing absenteeism from work in 45.3% of cases. Almost half of women reported that the onset of gynecological pain was before 15 years and 72.2% had consulted a physician in the past, with a mean delay of 2.5 ± 4.3 years between the onset of pain and medical consultation. However, only 28% of the overall population received a diagnosis. 51.0% received one treatment, while 39% received two or more. The first therapy was prescribed in 40.2% cases by the physician, while in the remaining it was recommended either by the pharmacist or it was a self-medication. Conclusion: Gynecological pelvic pain is a disabling problem, regardless of the underlying cause, with significant impact on social and working life and requiring a better medical management.

scholarly journals COMMUNITY PHARMACY ROLE IN UNIVERSAL HEALTH COVERAGE IN MOMBASA COUNTY

2021 ◽  
pp. 331-341
Author(s):  
Kailong J. M ◽  
Aggrey A ◽  
Mulinya S
Keyword(s):  
Community Pharmacy ◽  
Universal Health Coverage ◽  
Close Contact ◽  
Health Planning ◽  
Essential Medicines ◽  
Bivariate Analysis ◽  
Community Pharmacies ◽  
Health Coverage ◽  
Controlled Drugs ◽  
Universal Health

Community pharmacy role in universal health coverage was a qualitative study that entailed close contact to the role played by community pharmacies in healthcare provision. As a "small healthcare" in provision of pharmaceutical services, community pharmacies are required to be included in realization of Universal Health Coverage in Mombasa since it is among the Big 4 Agenda of the national government (MOH, 2013). The objective of the study was to determine community pharmacy role in universal health coverage. A descriptive cross sectional study design was used to collect both qualitative and quantitative data and the design estimate the prevalence of the outcome of interest commonly for the purpose of public health planning. A sample size of 196 was calculated using fishers formula. Data was collected using in-depth interviews and structured questionnaire were administered on a target population of community pharmacies health providers and clients seeking services respectively. The collected data was analysed using SPSS version 20 and interpreted using tables and pie charts. On community pharmacy practitioners respondents; 58% were male, 90.3% diploma holders in pharmacy, 39.8% registered with PPB and 65% had practised for less than two years. 78% of the respondents agree that community pharmacy has a role in UHC and there was 74% affordability of community pharmacy medicines. Bivariate analysis findings show that training and inspection on UHC (P=0.003) Covid 19 (p=0.000) and inspection fee (p=0.000). Accessibility; location of community pharmacies (p=0.000) and doctors attitudes (p=0.000). Essential medicines; acyclovir 200mg tablets (p=0.000), chlorpromazine 100mg tablets (p=0.000) and tetanus toxoid vaccine (p=0.000). Key determinants of community pharmacy role in UHC were diploma (AOR 666.7; CI 129.6-3429.5), Erythromycin 125mg suspension (AOR 120.3; CI 15.4-940.8), Acyclovir 200mg tablets (AOR 46.823; CI 17.7-124.1) and Occupation (AOR 45.271; CI 15.363-133.404. The study recommends reduction of tax on essential medicines, MOH revise the UHC policy to incorporate community pharmacies and empowerment on management of controlled drugs and vaccines in order to realize effective and efficient UHC in Kenya

scholarly journals The management of upper gastrointestinal symptoms: A study on community pharmacies in Italy

Pharmacia ◽  
2021 ◽  
Vol 68 (2) ◽  
pp. 401-409
Author(s):  
Enrico Keber ◽  
Paolo Rocco ◽  
Umberto M. Musazzi ◽  
Antonio M. Morselli-Labate ◽  
Nicolina P. Floris ◽  
...  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Cross Sectional Study ◽  
Community Pharmacies ◽  
Medication History ◽  
Self Medication ◽  
Cross Sectional ◽  
Therapeutic Class ◽  
Gi Symptoms ◽  
History Of ◽  
Upper Gastrointestinal

Upper gastrointestinal (GI) symptoms are usual complaints among patients presenting to Italian community pharmacies. However, information on treatment history of those patients is often lacking. This descriptive, cross-sectional study aims at exploring the medication history of individuals with upper GI tract symptoms visiting one of the 20 enrolled community pharmacies, over a period of 7 months, based on the administration of a questionnaire. Of 1,020 interviewees, 62.1% had asked for a medical consultation. The most frequent symptom was epigastric burning (31.8%), followed by acid regurgitation (14.6%) and post-prandial fullness (12.0%). Of the 1,609 therapies, proton pump inhibitors constituted the most represented therapeutic class (35.6%) followed by antacids (17.5%) and alginate-based products (17.2%). In treating symptoms, 38.1% of the patients do not seek medical advice, while 42.0% rely on non-prescription therapies. As findings suggest, support to patients with GI disorders in community pharmacies can be enhanced for a safer self-medication.

Changes in Hospital Financing and Organization and Their Impact on Hospital Performance

2019 ◽  
Author(s):  
Jonas Schreyögg
Keyword(s):  
Financial Performance ◽  
Financial Incentives ◽  
Hospital Performance ◽  
Unintended Effects ◽  
Natural Experiments ◽  
Cross Sectional ◽  
Trade Offs ◽  
Wide Range ◽  
Improve Hospital ◽  
The Impact

Since the 1980s policymakers have identified a wide range of policy interventions to improve hospital performance. Some of these have been initiated at the level of government, whereas others have taken the form of decisions made by individual hospitals but have been guided by regulatory or financial incentives. Studies investigating the impact that some of the most important of these interventions have had on hospital performance can be grouped into four different research streams. Among the research streams, the strongest evidence exists for the effects of privatization. Studies on this topic use longitudinal designs with control groups and have found robust increases in efficiency and financial performance. Evidence on the entry of hospitals into health systems and the effects of this on efficiency is similarly strong. Although the other three streams of research also contain well-conducted studies with valuable findings, they are predominantly cross-sectional in design and therefore cannot establish causation. While the effects of introducing DRG-based hospital payments and of specialization are largely unclear, vertical and horizontal cooperation probably have a positive effect on efficiency and financial performance. Lastly, the drivers of improved efficiency or financial performance are very different depending on the reform or intervention being investigated; however, reductions in the number of staff and improved bargaining power in purchasing stand out as being of particular importance. Several promising avenues for future investigation are identified. One of these is situated within a new area of research examining the link between changes in the prices of treatments and hospitals’ responses. As there is evidence of unintended effects, future studies should attempt to distinguish between changes in hospitals’ responses at the intensive margin (e.g., upcoding) versus the extensive margin (e.g., increase in admissions). When looking at the effects of entering into a health system and of privatizations, there is still considerable need for research. With privatizations, in particular, the underlying processes are not yet fully understood, and the potential trade-offs between increases in performance and changes in the quality of care have not been sufficiently examined. Lastly, there is substantial need for further papers in the areas of multi-institutional arrangements and cooperation, as well as specialization. In both research streams, natural experiments carried out using program evaluation design are lacking. One of the main challenges here, however, is that cooperation and specialization cannot be directly observed but rather must be constructed based on survey or administrative data.

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