Polypharmacy among people living with type 2 diabetes mellitus in rural communes in Vietnam

Objectives People with diabetes are at high risk of polypharmacy owing to complex treatment of diabetes and comorbidities. Polypharmacy is associated with increased risk of adverse reactions and decreased compliance. Therefore, the objectives of this study were to assess polypharmacy in people with type 2 diabetes (T2D) and associated diabetes-related factors in rural areas in Vietnam. Method People with T2D (n = 806) who had received treatment for diabetes at a district hospital were invited to participate in a questionnaire-based cross-sectional survey. Polypharmacy was defined as ≥5 types of medicine and assessed as a) prescription medicine and non-prescription/over the counter (OTC) medicine and b) prescription medicine and non-prescription/OTC, herbal and traditional medicine, and dietary supplement. Multiple logistic regression was used to investigate the association between polypharmacy and diabetes specific factors: duration, comorbidities and diabetes-related distress. Results Of the people with T2D, 7.8% had a medicine use corresponding to polypharmacy (prescription medicine and non-prescription/OTC), and 40.8% when herbal and traditional medicine, and dietary supplement were included. Mean number of medicine intake (all types of medicines and supplements) were 3.8±1.5. The odd ratios (ORs) of polypharmacy (medicine and supplements) increased with diabetes duration (<1–5 years OR = 1.66; 95%CI: 1.09–2.53 and >5 years OR = 1.74; 95%CI: 1.14–2.64 as compared to ≤1-year duration of diabetes), number of comorbidities (1–2 comorbidities: OR = 2.0; 95%CI: 1.18–3.42; ≥3 comorbidities: OR = 2.63;95%CI: 1.50–4.61 as compared to no comorbidities), and suffering from diabetes-related distress (OR = 1.49; 95%CI: 1.11–2.01) as compared to those without distress. Conclusions In rural northern Vietnam, persons with longer duration of T2D, higher number of comorbidities and diabetes-related stress have higher odds of having a medicine use corresponding to polypharmacy. A high proportion of people with T2D supplement their prescription, non-prescription/OTC medicine with herbal and traditional medicine and dietary supplements.

Developing a User-focused Standardised Design System for Prescription Medicine Packaging in Slovenia

Introduction In my thesis I am exploring the role of pharmaceutical packaging design in relation to the user. This topic is becoming increasingly relevant as the number of issued prescriptions in Slovenia is rising every year, treatment with prescription medicine is experienced by almost everyone. Medicine packaging must therefore provide essential information effectively and efficiently. Aim The purpose of this thesis is to improve current heterogeneous conditions by developing a standardized design system for all prescription drugs by taking into account users’ needs at each stage of the process. The final goal is a simpler and more effective use of products for everyone involved. Methods Research was conducted in three stages. In the first stage, the existing condition in packaging design was analysed: information hierarchy/arrangement on 8 significant manufacturers’ products considering 1 - the type of information and 2 - different user groups. Second stage consisted of conducting surveys with 2 focus groups representing two main user groups who use the packaging differently - medicine consumers and healthcare professionals.(1) Consumer focus group consisted of 81 participants, recruited randomly from various age groups (age 10 to 89). They were asked closed-ended questions. Healthcare professionals focus group consisted of 5 pharmacists with extensive experience. They were asked open-ended questions. The collected data from both research stages was statistically and qualitatively analysed in order to define the main problems with medicine packaging design and use. Identified problems were then addressed through the design process. The third stage included development of a standardised design system in accordance with information design theory and cognitive psychology findings.(2) These helped establish the system building blocks/rules: information hierarchy and organization, use of colour, shape and typography. Results Analysis of existing conditions clearly exposed the heterogeneity and unsuitability of the majority of medicine packaging design. These caused similar problems to both user groups: trouble finding information (73 %), lack/redundancy of information (47 %/17 %), illegible, unreadable typography (39 %), distracting visual elements (26 %), unclear distinction between medicines (17 %). These lead to various consequences: incorrect route of administration (39 %), consuming/prescribing expired (30 %) or incorrect product (8 %), time loss (8 %). Each of these problems was addressed through establishment of new, highly precise rules in packaging design: regulating hierarchy and typography, introducing visual categorization through symbols and illustrations (information category, pharmaceutical form, ATC group) and color-coding medicine strength. The rules form a standardised system which provides unity, consistency and quality regulation, improving the everyday experience of many people. Conclusion The research was carried out as a part of a BA thesis. The execution of the project would require a change in the legislation on state level. It therefore serves as a speculative proposal, aiming to raise questions that are currently not being addressed properly within the industry. The possibility of implementation could be recognized through gradual transformation of individual rules/building blocks of the system into new state regulations or guidelines. Discussion with the industry and the profession has not yet been carried out due to the Covid-19 crisis. References 1. Heinio RL, RUSKO E, Van der Waarde K. Challenges to read and understand information on pharmaceutical packages [Internet]. 2012 Jun [cited 2020 May 24]; 79 - 85. Available from: https://www.vttresearch.com/sites/default/files/julkaisut/muut/2012/Rusko IAPRI_2012_Manuscript_final.pdf 2. Černe Oven P, Požar C. On Information Design [Internet]. Ljubljana: Muzej za arhitekturo in oblikovanje; 2016. 149 p. Available from: http://www.mao.si/Upload/file/Oninformation-design_e-book-spread.pdfEvaluation of the first pharmacy-led weight management programme in Greece.

Relationship between insurance and access and cost of care in patients with diabetes before and after the affordable care act

PurposeThe purpose of this paper is to examine the influence of insurance coverage changes over time for patients with diabetes on expenditures and access to care before and after the Affordable Care Act (ACA).Design/methodology/approachThe Medical Expenditure Panel Survey (MEPS) from 2002–2017 was used. Access included having a usual source of care, having delay in care or having delay in obtaining prescription medicine. Expenditures included inpatient, outpatient, office-based, prescription and emergency costs. Panels were broken into four time categories: 2002–2005 (pre-ACA), 2006–2009 (pre-ACA), 2010–2013 (post-ACA) and 2014–2017 (post-ACA). Logistic models for access and two-part regression models for cost were used to understand differences by insurance type over time.FindingsType of insurance changed significantly over time, with an increase for public insurance from 30.7% in 2002–2005 to 36.5% in 2014–2017 and a decrease in private insurance from 62.4% in 2002–2005 to 58.2% in 2014–2017. Compared to those with private insurance, those who were uninsured had lower inpatient ($2,147 less), outpatient ($431 less), office-based ($1,555 less), prescription ($1,869 less) and emergency cost ($92 less). Uninsured were also more likely to have delay in getting medical care (OR = 2.22; 95% CI 1.86, 3.06) and prescription medicine (OR = 1.85; 95% CI 1.53, 2.24) compared with privately insured groups.Originality/valueThough insurance coverage among patients with diabetes did not increase significantly, the type of insurance changed overtime and fewer individuals reported having a usual source of care. Uninsured individuals spent less across all cost types and were more likely to report delay in care despite the passage of the ACA.