1,721,026 research outputs found
Introduction
No full textThe paper introduces the special Dossier of the PJSS linked to a recently completed research programme named "Flexible wages for flexible contracts? The dynamics of the relationship between wage policy and employment contracts at the firm level" (FLEX, 2010–2013), funded by the Portuguese Foundation of Science and Technology (Fundação para a Ciência e Tecnologia). The programme involved a Portuguese and an Italian research team and explored the wage policy patterns of medium and large firms
Accessing antiretroviral treatment in the rural Eastern Cape : patients' perceptions of a decentralised pre-packing model of care and the impact on direct out-of-pocket spending.
Get PDFM. Pharm. University of KwaZulu-Natal, Durban 2014.Background:
With an estimated 5.51 million HIV infected South Africans, HIV/AIDS contributes significantly to
the burden of disease in the country, with far-reaching socio-economic implications particularly for
poor and vulnerable groups. High out-of-pocket health expenditure associated with HIV/AIDS care
has a serious impact on vulnerable individuals and is likely to severely affect the wellbeing of the
affected household. Geographic inaccessibility of centralised, hospital-based antiretroviral treatment
(ART) services and excessive transportation costs may contribute to patient attrition and these
barriers are exacerbated in rural populations.
Aim:
The objectives of this study are to ascertain the out-of-pocket expenses that are incurred by patients
travelling to their ART down-referral site, and compare this with the out-of-pocket expenses of those
patients from the same catchment area still receiving their ART from the central hospital. The study
also aims to determine whether or not the down-referral programme has impacted the patients’
economic status and improved their treatment experience.
Methods:
A semi-quantitative cross sectional study design was employed. Zithulele Hospital ARV Clinic and
five different PHC collection points within the hospital’s catchment area were selected as the study
sites. Included in the study were 44 hospital-based patients and 73 clinic-based patients registered on
the Zithulele Hospital HIV Programme. Using a standard questionnaire, all socio-economic data and
information related to mode of transportation and associated costs, as well as other out-of-pocket
spending associated with accessing ART, was collected. Clinical data was recorded from patient
medical records during the interview.
Results:
The average monthly household income was R1653 (R301.05 per capita) for hospital-based patients
and R1617 (R392.66 per capita) for clinic-based patients. Income was predominantly sourced from
either child support or pension grants. Study participants had an overall unemployment rate of 94%
and, subsequently, 75% of hospital-based patients and 68.5% of clinic-based patients were living
below the food poverty line of R400 per month. A higher proportion of hospital-based patients used
taxis (80.5% versus 28.8%) while more clinic-based patients walked to the facility for their treatment
(71.2% versus 14.6%). In terms of monthly transport costs, hospital-based patients spent on average
R71.92, significantly more than the R25.81 spent by clinic-based patients. With a point estimate of
1.169, regression analysis indicated that for every one Rand increase on transport, the odds of the
patient being hospital-based rather than clinic-based are 16.9% higher. There were higher levels of
satisfaction recorded amongst the hospital-based group (95.5% compared to 89%) but despite this,
100% of the clinic-based patients listed their respective clinic as their preferred ART collection
point.
Conclusion:
Decentralisation and down-referral of patients to their nearest primary healthcare clinic minimises
out-of-pocket spending in rural communities while maintaining good levels of satisfaction with the
healthcare service provided. It is important to consider the social, geographical and cultural context
of the individuals seeking and utilizing healthcare before interventions are implemented
Investigating medicines availability for selected non-communicable diseases at Raleigh Fitkin Memorial Hospital, Manzini, Swaziland and the impact on patient out-of-pocket payments.
Get PDFM. Pharm. University of KwaZulu-Natal, Durban 2014.Background: The burden of non- communicable diseases (NCDs) in low and middle -income countries is greatly increasing and posing both financial and public health concerns. Increased morbidity has significantly reduced quality of life in these populations and Swaziland is no exception. Patients with NCD’s often have to pay for their medicines out-of-pocket. The extent of this practice is not known.
Methods: The study was conducted at a regional hospital in Manzini that serves majority of NCD patients in the central part of the country. Exit interviews were conducted with 300 patients diagnosed with diabetes, hypertension and asthma. Patients were asked how often they experienced stock-outs of essential medicines at the facility and how much they paid at private pharmacies to access the medicines. Responses were triangulated with Central Medical Stores’ (CMS) 2012 annual stock records to ascertain availability of the selected medicines and their turnaround time which was the time taken for medicines to be issued to the facility on receipt after they had been out of stock at CMS. Results were analyzed using the Statistical Package for Social Sciences (SPSS).
Results: Majority of patients (n=213; 71%) confirmed not receiving the complete package of their prescribed medicines at each visit to the hospital in the past six months. On average patients spent 10-50 times more for their medicines in private pharmacies than they would when accessing them from the health facility. Stock-outs at CMS ranged from minimum of 30 days to over 217 days in the course of the assessment period (12 months) were recorded and found to be the cause of stock-outs in the health facility. The turnaround time of medicines from CMS to the facility was not found to have influence on shortages recorded in facility.
Conclusion: Out-of-pocket expenditure is very common for patients with NCDs using this health facility which increases of the possibility of default on treatment because they cannot afford the commercial fees charged at private pharmacies. Patients were paying 10 to 50 times more to access medicines for their conditions in private pharmacies than when accessing them from the health facility in the event they were out-of-stock
A case study on the impact of international benchmarking on the price of medicines in South Africa using immunosuppressive medicines for transplant recipients for comparison.
Get PDFMaster’s Degree. University of KwaZulu-Natal, Durban.No abstract available
Determining the prevalence and scope of polypharmacy in geriatric patients at a private hospital in Pietermaritzburg, KwaZulu-Natal.
Get PDFM. Pharm. University of KwaZulu-Natal, Durban 2015.Background: Polypharmacy can be defined as the use of multiple medicines by a single
patient and includes inappropriate medicine use. This is common among the elderly,
especially in patients 60 years and older. The use of multiple medicines has been shown to
predispose patients to adverse medicine reactions.
Objective: The goal of this study was to determine if polypharmacy is prevalent in geriatric
patients in a private hospital in KwaZulu-Natal, Pietermaritzburg, and if so to determine the
extent of the problem.
Methods: A cross sectional descriptive study involving chart review of geriatric patients was
carried out in a hospital. Prescriptions were reviewed for concomitant use of five or more
medicines, adverse medicine reactions, therapeutic duplication, contraindications and
inappropriate use of medicines. Demographic data e.g. age, sex, and medical aid
membership were reviewed. Diagnosis, allergies and number of chronic disease states were
also analysed.
Results: The majority of the patients reviewed had between one to two chronic diseases.
The youngest age group 60-69 years age had the most number of patients with between 1-2
chronic diseases. Females outnumbered males in all three age categories reviewed. The
most common chronic disease was hypertension. The 120 study patients were prescribed a
combined total of 859 medicines. The average number of medicines per patient was 7.2
(used to determine the degree of polypharmacy) ranging from two to twenty one. A total of
75 % (n=90) of the study patients received 5 and more medicines. Prescription medicine use
was assessed according to gender of the study population. Polypharmacy was more
prevalent in females when compared to the males. Polypharmacy was prevalent in each age
category with the 60-69 years age group having the highest prevalence. Polypharmacy was
evident from the results obtained.
Conclusion: Prescribing trends in geriatric patients together with inappropriate medicine use
were identified. The results of this study can be used by healthcare professionals to be
aware of the prevalence of polypharmacy in their settings. Health care professionals can
adopt an informed approach to address the needs of the geriatric population regarding
polypharmacy. Strategies for pharmacists to manage polypharmacy can include medicine
review, communication with the prescriber and patient, reduction in a geriatrics regimen to
the fewest possible essential medicines. Prescribers and dispensers can utilize the
information to decide whether the medicine is essential and if the geriatric can tolerate
possible interactions or adverse effects
Direct treatment costs of invasive candidiasis in Haematology patients at a South African private hospital.
Get PDFMaster’s Degree. University of KwaZulu-Natal, Durban.ABSTRACT
Background: Haematology patients are at a high risk of developing invasive candidiasis (IC). Fluconazole has been the mainstay of prophylaxis and treatment but recently a newer class of therapeutic options, the echinocandins, has seen a considerable improvement in treatment success. However, these agents are associated with substantial acquisition costs when compared to fluconazole.
Objective: This study analysed the direct treatment costs of invasive candidiasis in haematology patients.
Methods: This is a retrospective, single-centre economic analysis of haematology patients with IC, at a private hospital in Durban, KwaZulu-Natal province, South Africa.. The direct medical costs related to managing IC were analysed. These included antifungal administration costs, hospital ward costs, haematologist consultation costs and laboratory costs for blood cultures. Adult patients (≥18 years old) diagnosed with a haematology disorder and a positive blood culture for Candida who were prescribed fluconazole and/or an echinocandin as treatment were included in the study, patients in the three groups were analysed separately and compared.
Results: There was a statistically significant difference for duration of antifungal treatment (p = 0.013) and antifungal administration costs (p = 0.003) between the three groups. Median overall direct treatment costs per patient were, ZAR110 365 for patients treated with fluconazole, ZAR219 915 for patients receiving an echinocandin and ZAR181 502 (for patients treated with both the antifungals. Overall hospital stay was the biggest cost contributor to the overall cost of treatment.
Conclusion: The results of this cost analysis found that treatment with fluconazole only is considerably less expensive, almost half of the mean daily treatment cost, when compared to an echinocandin only and treatment using both agents is still less expensive than an echinocandin as first line therapy.
1Abstract available in the PDF
The impact of the introduction of generics and generic references pricing and candesartan and rosuvastatin utilisation, price and expenditure in South Africa.
Get PDFMasters Degree. University of KwaZulu-Natal, Durban.Rationale for the study
The growth of pharmaceutical expenditure as a percentage of total health care expenditure has
stagnated, both locally and globally, despite increasing consumption. Two factors that contributed
to the stagnation are the introduction of generic medicines after patent expiry, and the
introduction of cost-containment policies, like generic reference pricing. The introduction of
generic medicines offer the opportunity to reduce medicine expenditure because of a switch in
utilisation from expensive brand-name originator products to more cost-effective generic
alternatives. Reference pricing is a policy where therapeutically similar medicines are grouped
together, and a maximum reimbursement rate is set for the group. If a patient chooses to use a
product more expensive than the reference price, they have to pay the difference in price. In the
South African context, generically similar products are grouped together and the reimbursement rate
is set at the average price of the generically equivalent products.
Aims and objectives
The aim of the study is to determine the impact of the introduction of generics and generic
reference pricing on two active ingredients, candesartan and rosuvastatin, which recently lost
their patent protection, in the South African private health care sector, for the period January
2012 to December 2015. To achieve this aim, three objectives were identified:
1. To measure the impact on medicine utilisation after the introduction of generics and generic
reference pricing on candesartan and rosuvastatin.
2. To measure the impact on the average medicine price after the introduction of generics and
generic reference pricing on candesartan and rosuvastatin.
3. To measure the impact on medicine expenditure after the introduction of generics and generic
reference pricing on candesartan and rosuvastatin.
Method
Medicine claims for candesartan and rosuvastatin was obtained from a Pharmacy Benefit Manager in
South Africa. The claims covered a 48-month period from January 2012 to December 2015 and provided
a pre- and post-reference price period for analysis. Medicine utilisation was measured as the number of Defined Daily Doses dispensed per 100 000 beneficiaries. Medicine price and expenditure was calculated as the average per Defined Daily Dose.
Results
Candesartan experienced an average 7.0% year-on-year decline in utilisation and rosuvastatin a 5.0% increase. Utilisation of generic medicines was 59.3% of the total volume in the final year of the study for candesartan and 76.4% for rosuvastatin. The introduction of generic alternatives resulted in a 31.0% reduction in the average price per Defined Daily Dose for candesartan and a 13.9% reduction for rosuvastatin. Medicine expenditure reduced by an additional 34.6% and 20.9% for candesartan and rosuvastatin respectively, because of the introduction of generic reference pricing. The total saving because of the introduction of generics and generic reference pricing was 54.8% for candesartan and 31.9% for rosuvastatin.
Conclusion
The introduction of generics and generic reference pricing did not have an impact on overall medicine utilisation, but reduced the price and expenditure of both candesartan and rosuvastatin
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Evaluating the impact of the change in regulations related to medicine pricing and pharmacy ownership in the private pharmaceutical sector of South Africa.
Get PDFDoctoral Degree. University of KwaZulu-Natal, Durban.One of the imperatives of the post-1994 government was to improve access to medicines and
related pharmaceutical services to previously disadvantaged areas. The government
implemented multiple strategies to achieve this goal.
The first was to ensure the availability of quality affordable medicines to all its citizens. In the
public sector, the government controlled the purchases through a tender system and ensured
the availability and affordability of medicines to the majority of the population free at the point
of service. In 2004 the government introduced the Single Exit Price (SEP), a transparent
pricing system in the private sector for all prescription medicines comprising of a fixed exfactory price with a logistics fee component (and value-added tax) for medicines sold to all
purchasers other than the State.
This study presents two papers that evaluated a basket of 50 originator medicines and its
available generics using the WHO/HAI methodology. Data were obtained from community
pharmacy and pharmacy software vendors and subjected to an Interrupted Time Series (ITS)
evaluation, where the changes in slope and levels of the medicines before and after regulations
were obtained.
A second strategy was to look at opening up ownership of pharmacies with the goal of
improving access to medicines and services. On 23 October 1997, Minister Zuma introduced
the amendment to the Pharmacy Bill that intended removing the restriction that ‘only people
registered as pharmacists may own a pharmacy.’ The objective of the open ownership policy
change was to increase public access to pharmaceutical services by increasing the number of
pharmacies, especially in outlying areas. This amendment came into effect in 2003.
While no extensive studies have been performed in South Africa to examine this change in
ownership impact, research has suggested that open ownership has contributed to the demise
of community pharmacy in rural areas (Blignault, 2010; Lowe, 2009). However, a
comprehensive longitudinal evaluation has not been undertaken to date. It is unclear whether
South Africa benefited from this policy or repeated the same mistakes as other countries, that
have deregulated ownership, have demonstrated.
The third paper examines the opening, transfer, and closing of all pharmaceutical licenses as
per the South African Pharmacy Council register prior to the changes in regulation and postregulations up to 2014. Each license was tracked over time and mapped at a municipal and
district level. The investigation further allowed for a population overlay to determine changes
in access, ownership categories, and urban-rural access over time, and in this way, examined
the impact of the change in policy and whether its intended outcomes were achieved. It
addressed the gap in research and evidence in terms of the policy on the deregulation of
pharmacy ownership. The research contributed to lessons for low- and middle-income (LMIC)
countries, especially those on the African continent.
Conclusions:
Using interrupted time series methodology, the research confirmed that substantial price
reductions were achieved through the Single Exit Price regulations. This was true in both the
originator and generic medicine where possible savings were experienced in the private sector.
While the liberalisation of the ownership laws in South Africa may have increased the number
of pharmacies in the country it did not result in increased access in previously disadvantaged
and rural areas to any marked degree
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