Perspectives of Dental Practitioners Regarding Their Readiness for Medical Emergencies: A Study in Saudi Arabia

Background: Training dental practitioners on emergency preparedness and response is essential for the successful management of medical emergencies. Objectives: To assess the perceptions of dental practitioners in Saudi Arabia about their readiness to manage medical emergencies in the dental practices. Methods: This cross-sectional survey was conducted among dental practitioners working in 52 dental centers in Saudi Arabia. Questionnaires mainly gathered data on the measures taken by dental practitioners to prevent medical emergencies, BLS certification, availability of essential drugs and equipment, and perceptions of dental practitioners regarding the adequacy of their training for medical emergencies. Results: Of the total 270 participants, the majority reported that they take medical history (94%), perform visual inspection (90%), consult with patients’ physician when needed (89%), and modify treatment plan as necessary (94%). However, only 19% of them routinely take baseline vital signs for their patients and 52.6% have valid BLS certification. Only 29.6% and 16.3% of dental practitioners have reported that they have all essential drugs and equipment, respectively. Conclusion: The preventive measures for medical emergency appears to be deficient because most dental practitioners are not routinely taking baseline vital signs for their patients. This important issue is combined with shortage of BLS certification among dental practitioners and inadequate availability of all medical emergency drugs and equipment in dental practices.

Determinants of Accessibility of Hypertensive Drugs by Adult Patients Under Sustainable Development Goal Three in Nairobi City County, Kenya

Hypertension is noted to be the easiest non-communicable disease to diagnose treat and monitor if proper health systems are put in place to ensure hypertensive drugs are accessible to hypertensive patients who need them daily. It is estimated that prevalence rate of hypertension in Kenya range from 13 % to 50 % and only 1 in 5 of the diagnosed are on hypertensive medicines. Lack of medication intake leads to uncontrolled hypertension resulting to more serious health complications which result to premature deaths. Previous studies have provided little information on the determinants of hypertensive drugs accessibility to patients. An enquiry on the availability of hypertensive drugs in public hospitals is worthwhile because hypertension has become an important social problem. This study has investigated the determinants of accessibility of hypertensive drugs by adult patients who are supposed to have uninterrupted medication intake for a healthy living. The concept of essential drugs was adopted for this study. This concept of essential drugs contained essential medicines list (EML) and the eight elements of primary health care of 1978 with a goal to ensure equal access to medicines. Descriptive design has been adopted for the study. The targeted population of 6329 hypertensive patients in public health facilities within Nairobi County. Yamane formula was used to get the sample size, which will be a total of 394 patients. Systemic random sampling procedure was employed for the study. A questionnaire tool of data collection was used for data collection. The collected data was there after coded and analyzed using Statistical Package for Social Sciences (SPSS) both for descriptive statistics (frequencies and percentages) and inferential statistics (correlation analysis). Data is presented using pie charts tables and figures. The study revealed that accessibility of medication in Nairobi city county health facilities is contributed by lack of medication in the facilities.

Structural Quality of Labour and Delivery Care in Government Hospitals of Ethiopia: A Descriptive Analysis

Background Ethiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labour and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia. Methods A facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People’s Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labour and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labour and delivery care. Results One third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.5% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (78.9%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%). Conclusion Substantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.

STUDY OF DRUG UTILIZATION PATTERNS IN POSTPARTUM WOMEN IN GOVERNMENT MEDICAL COLLEGE, JAMMU (INDIA).

Background: There is a paucity of literature regarding rational prescribing practices especially during postnatal period.It was found worthwhile to assess the drug utilization patterns during postpartum period.It is known fact that the drugs prescribed during postnatal period have significant impact on the health of both mother and child. Material and Methods:A total of 1300 prescriptions of the patients which include 552 caesarian sections (cs) and 748 pervaginal (pv) delivery were randomly selected and studied. Results:It was recorded that the average number of drugs prescribed per prescription were 6.01 in cs patients and 10.95 in pv delivery group.The most commonly drugs that were prescribed were Antibiotics, analgesics, anti-inflammatory drugs, nutritional supplements (iron, calcium, multivitamins), H2 blockers and proton pump inhibitors (PPIs).In addition the other drugs included were oxytocin,prostaglandins,uetrine relaxants,antihyperttensives,bronchodilators,benzodiazepines,antifungal agents and antiepileptics.It was also found that 36.88%,16.75%,80.71% and 6.33% drugs prescribed were fixed dose combinations,generics,essential drugs and off label respectively in cs patients.Whereas, 42.96%, 13.23%, 78.81% and 8.2% drugs prescribed were fixed dose combinations, generic, essential drugs and off label respectively in pv patients. Conclusion: The results of this study reveals that there is need for educating prescribers regarding rational prescribing practices, especially during postnatal period when health of both infant and mother is at stake.

Systematic Review of the Effect of a Zero-Markup Policy for Essential Drugs on Healthcare Costs and Utilization in China, 2015–2021

Objective: This systematic review aimed to discuss the effects of a zero-markup policy for essential drugs (ZPED) on healthcare costs and utilization in China in the years 2015–2021.Methods: We searched the PubMed, Embase, Scopus, and CINAHL databases for all associated studies carried out from January 1, 2015, to May 31, 2021, without any limitations regarding the language the studies were written in. To prevent selection bias, gray documents were tackled by other means. The methodological approaches were assessed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Newcastle-Ottawa Scale (NOS) collaboration tool.Results: Forty studies were selected at first and then 15 studies that met the inclusion criterion. Most of the studies showed a considerable decrease in total medical spending and drug spending in both outpatient and inpatient services. After the implementation of ZPED, studies showed that the medical services increased and total hospital income sustained, despite a decrease in drug revenue. Minimal or no government subsidy is required from a financial perspective.Conclusions: Although, the government could implement ZEPD with lower medical cost and drug cost to patients, and sustained income for health facilities, we have limited understanding of whether the increase in medical services was induced by the provider or was a response to unmet needs in the population. Further, studies using rigorous and advanced methods to study health policy, patient behaviors, provider behaviors, and government decisions are warranted.

Avability of Essential Medicines and Inventory Management Practice at Public Health Centers in Bahirdar Town West Gojjam Zone, Amhara Region, Ethiopia, 2020.

Background Essential medicines are medicines that satisfy the priority health care needs of the population. These medicines are selected with due regard to disease prevalence and public health relevance, evidence of clinical efficacy and safety, and comparative costs and cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. Objective To assess availability of essential medicine and inventory management practice at public health centers in Bahir Dar town. Method: Institutional based cross sectional study design conduct among six HCs in Bahir Dar town. Checklists were used according to Ems lists from the Amhara region health bureau to assess the availability of essential medicine. IMAT was used to review the essential drugs inventory records of tracer drugs and examine stock records and historical stock outs. An observational method was applied on physical stock of the inventory and the inventory record at the day of visit to check for stock availability, inventory accuracy, stock out durations and stock record variation. Results According to the study the average percent of time out of stock was 26.2%; the average percent of essential drugs available on the day of assessment was 74.7%. The average percentage of stock keeping records were accurate (56.7%), this study found that records were greater than physical counts (22.7%) and the average ratio of inventory variation to total stock was 33.7%. Discussion and recommendation: The availability of Ems in Bahirdar public health centers was poor. Inaccurate stock keeping record was observed irrespective of health centers level. For increasing inventory management: timely entries to logistic tool, updated records, updated stock status and when drugs are issued from the health facilities store room to different units, the date of issue and quantity issued being recorded on the available logistics tool were necessary.

Analysis of the correspondence of the lists of drugs for cancer patients' treatment included in the territorial programs of state guarantees to the list of vital and essential drugs

The aim of the study was to study the compliance of the list of drugs for the treatment of malignant neoplasms in the territorial state guarantee programs (TSGP) with the list of vital and essential drugs (VED) in the constituent entities of the Russian Federation and the practice of purchasing drugs at the expense of regional preferential provision (RPP) funds. Material and methods. The analyzed territorial programs of state guarantees were compared with the list of drugs for RPP for the patients with malignant neoplasms with the VED. An assessment of medication procurement in 2019 and 2020 was carried out and compared with the current list of RLO in all constituent entities of the Russian Federation. Results. Only 14% of the Russian Federation regions in 2019 and 20% in 2020 met the territorial state program of guarantees requirement. The average number of medications included in the territorial state program of guarantees was 73 INNs in 2019 and 100 INNs in 2020. The number of regions with a complete list of drugs accounted for 7% to 33% in the corresponding Federal Districts. In 2020 the number of regions with a complete list of medications in a territorial program of state guarantees did not change. Discussion. Reduction of medications from the VED purchased at the expense of RPP reduces the number of possible treatment regimens, and limits oncologists’ ability to provide care on an outpatient basis. Conclusion. Most Russian Federation regions violate the requirements of the territorial program of state guarantees do not harmonize the list of medications in the Program with EDL. The practice of purchasing medications from the territorial program of state guarantees indicates the absence of finance mechanisms for providing medications to patients at the outpatient stage of treatment.

Agenda setting for essential medicines policy in sub-Saharan Africa: a retrospective policy analysis using Kingdon’s multiple streams model

Background Lack of access to essential medicines presents a significant threat to achieving universal health coverage (UHC) in sub-Saharan Africa. Although it is acknowledged that essential medicines policies do not rise and stay on the policy agenda solely through rational deliberation and consideration of technical merits, policy theory is rarely used to direct and guide analysis to inform future policy implementation. We used Kingdon’s model to analyse agenda setting for essential medicines policy in sub-Saharan Africa during the formative phase of the primary healthcare (PHC) concept. Methods We retrospectively analysed 49 published articles and 11 policy documents. We used selected search terms in EMBASE and MEDLINE electronic databases to identify relevant published studies. Policy documents were obtained through hand searching of selected websites. We also reviewed the timeline of essential medicines policy milestones contained in the Flagship Report, Medicines in Health Systems: Advancing access, affordability and appropriate use, released by WHO in 2014. Kingdon’s model was used as a lens to interpret the findings. Results We found that unsustainable rise in drug expenditure, inequitable access to drugs and irrational use of drugs were considered as problems in the mid-1970s. As a policy response, the essential drugs concept was introduced. A window of opportunity presented when provision of essential drugs was identified as one of the eight components of PHC. During implementation, policy contradictions emerged as political and policy actors framed the problems and perceived the effectiveness of policy responses in a manner that was amenable to their own interests and objectives. Conclusion We found that effective implementation of an essential medicines policy under PHC was constrained by prioritization of trade over public health in the politics stream, inadequate systems thinking in the policy stream and promotion of economic-oriented reforms in both the politics and policy streams. These lessons from the PHC era could prove useful in improving the approach to contemporary UHC policies.

PHARMACOECONOMIC ANALYSIS IN PARENTERAL AND ENTERAL NUTRITION: METHODOLOGICAL FEATURES IN THE CONDITIONS OF RUSSIAN HEALTHCARE

The presence in Russia of legally approved rules for the pharmacoeconomic assessment of drugs when considering their inclusion in the lists of vital and essential drugs (reimbursement), as well as in the list of medical nutrition for children with disabilities, has features of pharmacoeconomic analysis of parenteral and enteral nutrition. Since parenteral and enteral nutrition can have different legal status - a drug (MP), biologically active additive (BAA) and even medical products, the rules for pharmacoeconomic assessment at the federal level will be different for them.