Experience for Glaucoma Patients During the COVID-19 Outbreak

Purpose: To reviewed our measures and other experiences associated with the treatment of glaucoma patients during the 2019 novel coronavirus disease (COVID-19) outbreak . Methods: Measures consistent with the clinical situation and the type of glaucoma were implemented in each case. Results: Consultation for treatment was provided through a WeChat glaucoma patient group. In our survey, 58.5%patients indicated an increase in negative emotions during the outbreak, and psychological counseling was provided frequently. Difficulties in purchasing eye drops were reported by 79.2% of glaucoma patients, so an online medicine supply system was set up and eyedrops from the pharmacy or hospital pharmacy were mailed to the patients. Phacoemulsification with goniosynechialysis was performed in7acute primary angle-closure glaucomapatients (11eyes) who experienced sustained high IOP(onset time, 12-65d). The IOP decreased significantly after the operation(t=7.895，P<0.01) without showing serious complications or infections. In addition, lectureson glaucoma prevention were promoted online. Conclusion: Effective measures can relieve thepsychological pressure and intraocular symptoms in glaucoma patientsin epidemic outbreak areas.

Changes in dispensing of medicines proposed for re-purposing in the first year of the COVID-19 pandemic in Australia

PurposeWe quantified changes in dispensing of common medicines proposed for “re-purposing” due to their perceived benefits as therapeutic or preventive treatments for COVID-19 in Australia, a country with relatively low COVID-19 incidence in 2020.MethodsWe performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidised medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analogue). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models (ARIMA) and compared characteristics of initiators in 2020 and 2019.ResultIn March 2020, we observed a 99% (95%CI 96%-103%) increase in hydroxychloroquine dispensing (of which approximately 30% attributable to new use), and a 201% increase (95%CI 186%-215%) in initiation, with a shift towards prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsidised following regulatory restrictions on prescribing to relevant specialties. There was also a small but sustained increase in ivermectin dispensing over multiple months, with a 80% (95%CI 42%-119%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April 2020. Other than increases in March related to stockpiling among existing users, we observed no increases in initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin remained low after March 2020.ConclusionsMost increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users. However, we observed increases in initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns, indicating that a small proportion may be COVID-19 related. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harms.Key pointsIn Australia, a country with low incidence of COVID-19 in 2020, most increases in dispensing of medicines proposed for re-purposing for treatment or prevention of COVID-19 were temporary and appeared to be related to stockpiling among existing usersWe observed a dramatic increase in new users of hydroxychloroquine in March and April 2020, with a shift toward prescribing by general practitioners instead of rheumatologists which subsided after the introduction of restrictions on its prescribing by non-specialistsDispensing of ivermectin also increased during COVID-19, but occurred later and was spread out over several monthsWhen such situations arise, a quick response by regulators can help limit inappropriate repurposing to reduce the potential for medicine supply shortages and patient harms

Assessment of Storage and Inventory Practices to Improve Medicine Supply Chain in Jubek State South Sudan

BackgroundIn order to deliver quality health services, safe, effective, affordable and quality medicines are needed. Inappropriate storage conditions, poor infrastructure and poor medicine management practices may lead to poor medicines quality, stock damage and expiration.ObjectiveAssess storage and inventory practices to improve the medicine supply chain in South Sudan.MethodologyThe study used a descriptive cross-sectional design. The study population comprised 12 Health Centers in Juba where inventory management was practiced. Both questionnaire‐guided interviews for staff self‐assessment, and observer assessment were used by the researcher. With regard to storage and inventory management, the researcher collected data on the condition of storerooms with regards to availability of enough storage space, availability of enough storage equipment, and temperature conditions of the medicines stores, among others.ResultsThe study found that store and inventory management practices varied widely in the different health facilities. Hospitals and central medical stores exhibited good or average inventory and storeroom management practices, respectively. The two hospitals and medical stores scored 100% in the elements in the assessment of storerooms and stock management. Some primary health care centers exhibited good inventory and store room management practice, whilst others were rated as average or poor. Most of the elements assessed scored 37% in storeroom assessment while elements assessed for inventory management scored less than 75%. There was great similarity between the observation assessment and the self-assessment.ConclusionIn conclusion, store and inventory management practices and knowledge of the respondents varied in the different health facilities. Hospitals and central medical stores exhibited good, average and poor inventory and storeroom management practices assessed through self-assessment and observation assessment by the researcher. There was a great similarity between the observation assessment and the self-assessment. Rwanda J Med Health Sci 2021;4(2): 310-320

The Medicine Supply System of the Qing Court

To secure the supply of medicinal products for the Qing palace, the court took a series of measures to mobilize several institutions to participate in the operation. The operation resulted in a comprehensive, flexible, and multivariate supply system. Although many offices were involved in the system, all of them were under imperial control. The central government’s strong vertical control over the regional societies facilitated the smooth operation of the system. The collaboration of various institutions ensured the functioning of medicinal projects for the Qing court.

Design of a CPFR, Location, Inventory and Routing Approach to Diabetes and High Blood Pressure Medicine Supply Network Planning

Objective: Designing a CPFR (collaborative planning forecasting and replenishment) model for the delivery of diabetes and arterial hypertension medicines from a health insurance company (EPS) to a healthcare provider (IPS) and comparing the performance of this collaborative chain to that of the traditional one through their corresponding supply chain costs. Methodology: A series of collaboration agreements involved in joint planning were established according to the designed CPFR model. This allowed (i) raising the levels of interaction between the health insurance company, the healthcare provider, the supplying pharmaceutical laboratories, and the patients; (ii) determining demand forecasts; (iii) locating distribution centers; and (iv) defining medicine distribution strategies oriented to the minimization of costs along the chain. Subsequently, the main differences between the current operation and CPFR models at the level of structure and decisions were characterized and then evaluated in terms of supply chain costs. Results: The significant impact of the proposed model is demonstrated. The total monthly cost of operating the chain is reduced by 11.2 % on average. Within the proposed innovation, an outstanding place is held by the savings reached in the purchase and distribution of medicines from the laboratory to the distribution centers, and by the customer satisfaction differences, which increased 15.3 % on average during the studied six-month period.