scholarly journals Does price-cap regulation work for increasing access to contraceptives? Aggregate- and pharmacy-level evidence from Colombia

2020 ◽  
Author(s):  
Tatiana Andia ◽  
Cesar Mantilla ◽  
Alvaro Morales ◽  
Santiago Ortiz ◽  
Paul Rodriguez-Lesmes
Keyword(s):  
Fixed Effects ◽  
Economic Status ◽  
Price Reduction ◽  
Community Pharmacies ◽  
Price Cap Regulation ◽  
Competitive Response ◽  
Price Cap ◽  
Product Categories ◽  
Product Availability ◽  
Before And After

Background: Price caps through international reference pricing are widely used around the World, but not so commonly in over-the-counter markets (OTC). We study this type of regulation for the case of oral contraceptives in Colombia, which is a de facto OTC market. Objectives: We aim to establish whether the regulation triggered a competitive response within and across product categories (active pharmaceutical ingredients).We also study whether regulated products targeted to customers from high socio-economic status are now distributed in pharmacies from low socio-economic neighborhoods.Methods: First, we use a fixed effects linear panel model to estimate the change in prices and quantities associated with the new regulation for regulated and non-regulated products using administrative data at the wholesale level, according to three price tiers. Second, we conducted an audit study with 213 community pharmacies in the city of Bogotá, Colombia. We visited pharmacies twice, before and after the introduction of the price cap, collecting information on prices and availability of six selected brands. Findings: The wholesale-level analysis reveals a price reduction in regulated and non-regulated products with a regulated active ingredient. Traded quantities increase for the same product types, but only for those in the most expensive categories. Besides, the traded quantities of non-regulated products decrease.However, the traded quantities of non-regulated products in the Top, Intermediate, and Bottom price categories decreased. Although this price reduction is also transmitted to community pharmacies, the availability of the high-end and mid-range contraceptives included in our audit study decreases as well. We provide suggestive evidence that reduction in the availability of was larger in areas of low socio-economic status.Conclusions: Price cap regulations that might look as effective in lowering prices and expanding access at the aggregate level could conceal stocking patterns that negatively affect the product availability for the final consumer.

scholarly journals The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies

2021 ◽  
Vol 12 ◽  
pp. 204209862199609
Author(s):  
Florine A. Berger ◽  
Heleen van der Sijs ◽  
Teun van Gelder ◽  
Patricia M. L. A. van den Bemt
Keyword(s):  
Decision Support ◽  
Drug Interactions ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Community Pharmacies ◽  
Support Tool ◽  
Interacting Agents ◽  
Before And After ◽  
Structured Approach

Introduction: The handling of drug–drug interactions regarding QTc-prolongation (QT-DDIs) is not well defined. A clinical decision support (CDS) tool will support risk management of QT-DDIs. Therefore, we studied the effect of a CDS tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. Methods: An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of three months were included. The impact of the use of a CDS tool to support the handling of QT-DDIs was studied. For each QT-DDI, handling of the QT-DDI and patient characteristics were extracted from the pharmacy information system. Primary outcome was the proportion of QT-DDIs with an intervention. Secondary outcomes were the type of interventions and the time associated with handling QT-DDIs. Logistic regression analysis was used to analyse the primary outcome. Results: Two hundred and forty-four QT-DDIs pre-CDS tool and 157 QT-DDIs post-CDS tool were included. Pharmacists intervened in 43.0% and 35.7% of the QT-DDIs pre- and post-CDS tool respectively (odds ratio 0.74; 95% confidence interval 0.49–1.11). Substitution of interacting agents was the most frequent intervention. Pharmacists spent 20.8 ± 3.5 min (mean ± SD) on handling QT-DDIs pre-CDS tool, which was reduced to 14.9 ± 2.4 min (mean ± SD) post-CDS tool. Of these, 4.5 ± 0.7 min (mean ± SD) were spent on the CDS tool. Conclusion: The CDS tool might be a first step to developing a tool to manage QT-DDIs via a structured approach. Improvement of the tool is needed in order to increase its diagnostic value and reduce redundant QT-DDI alerts. Plain Language Summary The use of a tool to support the handling of QTc-prolonging drug interactions in community pharmacies Introduction: Several drugs have the ability to cause heart rhythm disturbances as a rare side effect. This rhythm disturbance is called QTc-interval prolongation. It may result in cardiac arrest. For health care professionals, such as physicians and pharmacists, it is difficult to decide whether or not it is safe to proceed treating a patient with combinations of two or more of these QT-prolonging drugs. Recently, a tool was developed that supports the risk management of these QT drug–drug interactions (QT-DDIs). Methods: In this study, we studied the effect of this tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of 3 months were included. Results: Two hundred and forty-four QT-DDIs pre-implementation of the tool and 157 QT-DDIs post-implementation of the tool were included. Pharmacists intervened in 43.0% of the QT-DDIs before the tool was implemented and in 35.7% after implementation of the tool. Substitution of one of the interacting agents was the most frequent intervention. Pharmacists spent less time on handling QT-DDIs when the tool was used. Conclusion: The clinical decision support tool might be a first step to developing a tool to manage QT-DDIs via a structured approach.

Modeling investment behavior under price cap regulation

2008 ◽  
Vol 17 (2) ◽  
pp. 111-129 ◽  
Author(s):  
Thomas Nagel ◽  
Margarethe Rammerstorfer
Keyword(s):  
Investment Behavior ◽  
Price Cap Regulation ◽  
Price Cap

Strategic Nonlinear Pricing under Price-Cap Regulation

1992 ◽  
Vol 23 (1) ◽  
pp. 1 ◽  
Author(s):  
David E. M. Sappington ◽  
David S. Sibley
Keyword(s):  
Nonlinear Pricing ◽  
Price Cap Regulation ◽  
Price Cap

scholarly journals Cognitive output of a neuropsychological stimulation program in an elderly day care center with low educated participants: An observational study

2014 ◽  
Vol 8 (2) ◽  
pp. 162-168
Author(s):  
Maria Vânia Silva Nunes ◽  
Ana Almeida Pinho ◽  
Helena Mauricio Campos ◽  
Paula Abreu ◽  
Isabel Pinto Gonçalves ◽  
...  
Keyword(s):  
Observational Study ◽  
Day Care ◽  
Economic Status ◽  
Care Center ◽  
Cognitive Stimulation ◽  
Community Based ◽  
Day Care Center ◽  
Social Economic Status ◽  
Before And After ◽  
Low Educated

ABSTRACT Objective: In the present paper we present an observational study of the implementation of a Neuropsychological Stimulation Program at an Elderly Day Care Center in low-educated participants with very similar backgrounds concerning social economic status. Methods: The implemented program tackled several dimensions, including daily orientation sessions, cognitive stimulation sessions twice a week, followed by movement sessions, and structured sessions conducted every two weeks. Cognitive Evaluation was performed before and after implementation of the program. Results: Results are discussed taking into consideration cognitive outputs as well as non-cognitive outputs and the specificities of community-based intervention. Conclusion: It was concluded that community-based intervention is set to become vital in promoting dementia prevention.

scholarly journals Effectiveness of music therapy on reading skills of pupils with intellectual disability

2021 ◽  
Vol 16 (1) ◽  
pp. 251-265
Author(s):  
Udeme Samuel Jacob ◽  
Jace Pillay
Keyword(s):  
Intellectual Disability ◽  
Data Analysis ◽  
Music Therapy ◽  
Reading Skills ◽  
Economic Status ◽  
Analysis Of Covariance ◽  
Special Schools ◽  
Socio Economic Status ◽  
Before And After ◽  
Post Test

Objective: Reading is an indispensable skill. The study investigated the effects of music therapy on the reading skills of pupils with intellectual disability. Methods: An experimental research design was used. The sample was purposively selected from two special schools for pupils with intellectual disability in Ibadan, Nigeria. Seventeen pupils were randomly assigned to two groups (music therapy and control groups). Eighteen sessions of music therapy were conducted with the experimental group only. The Reading Skills Test was used before and after the intervention to collect data. Analysis of Covariance (ANCOVA) was used for data analysis. Results: The data indicated that there was a significant statistical difference between pre-test and post-test results. The interaction effect of treatment and parents’ socio-economic status was not significant for the participants’ reading. Conclusion: Music therapy enhanced the reading skills of pupils with intellectual disability and should be adopted in teaching pupils with intellectual disability.   Keywords:  Music therapy; parents’ socio-economic status; pupils with intellectual disability; reading skills

scholarly journals Learning loss due to school closures during the COVID-19 pandemic

2021 ◽  
Vol 118 (17) ◽  
pp. e2022376118 ◽  
Author(s):  
Per Engzell ◽  
Arun Frey ◽  
Mark D. Verhagen
Keyword(s):  
The Netherlands ◽  
Fixed Effects ◽  
School Funding ◽  
Learning Loss ◽  
School Closures ◽  
Cumulative Impact ◽  
School Year ◽  
Before And After ◽  
Face To Face Instruction ◽  
Rich Data

Suspension of face-to-face instruction in schools during the COVID-19 pandemic has led to concerns about consequences for students’ learning. So far, data to study this question have been limited. Here we evaluate the effect of school closures on primary school performance using exceptionally rich data from The Netherlands (n ≈ 350,000). We use the fact that national examinations took place before and after lockdown and compare progress during this period to the same period in the 3 previous years. The Netherlands underwent only a relatively short lockdown (8 wk) and features an equitable system of school funding and the world’s highest rate of broadband access. Still, our results reveal a learning loss of about 3 percentile points or 0.08 standard deviations. The effect is equivalent to one-fifth of a school year, the same period that schools remained closed. Losses are up to 60% larger among students from less-educated homes, confirming worries about the uneven toll of the pandemic on children and families. Investigating mechanisms, we find that most of the effect reflects the cumulative impact of knowledge learned rather than transitory influences on the day of testing. Results remain robust when balancing on the estimated propensity of treatment and using maximum-entropy weights or with fixed-effects specifications that compare students within the same school and family. The findings imply that students made little or no progress while learning from home and suggest losses even larger in countries with weaker infrastructure or longer school closures.

Processing Effect on Antioxidant Composition of Processed Products of Wild Edible Fruits of Sikkim Himalayas

2021 ◽  
Vol 16 (11) ◽  
pp. 129-133
Author(s):  
Ningma Doma Sherpa ◽  
Karma Diki Bhutia
Keyword(s):  
Local Community ◽  
Economic Status ◽  
Bioactive Compound ◽  
Significant Loss ◽  
Processing Effect ◽  
Wild Fruits ◽  
Hippophae Salicifolia ◽  
Before And After ◽  
Wild Edible Fruits ◽  
Processed Products

The processing effect on the processed products of wild edible fruits found in Sikkim Himalayas namely Chuirri (Diploknema butyracea), Achuk (Hippophae salicifolia), Mehel (Docynia indica), Muslendi (Elaeagnus latifolia) and Famphal (Machilus edulis) was quantified in this study. The value of the fruits is high enough to contribute and enhance the nutrient daily requirements of humans. Therefore, a study to assess the loss or change in their antioxidant composition before and after processing was carried out. The phytochemical characteristics of the fruits were analyzed according to standard methods on both the fresh and its various processed products. Comparing all the five wild fruits and their processed products, it was observed that there was a significant loss of nutrients during processing which occurred in its bioactive compound and composition of their processed foods. Although it has a potential to be a source of antioxidants, other nutrients also implement for utilization as food preserves and consumed in the form of food supplements. It will be promote the nutritional potential of the wild fruits as well as add value to the processed products among local people for consumer acceptability which can be further fortified as export items and to uplift the socio-economic status of the local community.

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