Angiotensin II inhibitors or Angiotensin Receptor Blockers (ARB s) are the most recent addition to the suite of antihypertensives. They are also one of the most expensive of the drug classes. Since the introduction of the first ARB on the market, the merits of ARB s have been investigated. The mechanism of action and indications are similar to ACE inhibitors thus comparisons have been done between the two classes to ascertain if there are any added benefits in using ARB s. This study was an analysis of out of hospital chronic medication claims from a managed care organisation in South Africa to view the utilisation pattern of ARB s and to establish if there were any indications for the choice of this specific drug class for the conditions hypertension and heart failure.. A managed care organisation aims to provide clinically appropriate and cost effective medication to its members. It is therefore important to investigate if there are any reasons for a more expensive drug to be used if there is a more cost effective alternative available. The medication claims for ARB s were investigated, in relation to ACE inhibitors to try and establish if there were any specific reasons for the use of ARB s. From the results obtained, it was evident that ACE inhibitors and ARB s were widely used within the managed care organisation and made up a high percentage of the amount spent on antihypertensive drugs. The gender utilisation patterns showed that more males used ACE inhibitors and ARB s for both hypertension and heart failure, although there were more females registered for these conditions within the organisation. The incidence of hypertension and heart failure was more prevalent in the over 45 year old age group and the use of these antihypertensive medications mirrored this. ARB s were the most expensive class of drugs used for hypertension and heart failure, and there was no reason found to support the specific use of these agents.

Doctor Educationis / Background: Since 2005 the Chronic Dispensing Unit (CDU) has been part of the Western Cape Government’s strategy to address increasing demand for chronic medication for patients with non-communicable diseases. However, some patients are unable to collect their pre-packed chronic medication parcels from health care facilities on the due date. Recent research reported that some patients utilise collectors or medicine agents to collect their prepacked chronic medication parcels. Currently little is known about this phenomenon of collectors. Aim and Objectives: This study explored the acceptability of collectors of CDU chronic medication parcels to improve access to medicines for patients with non-communicable diseases at Lotus River Community Day Centre (LRCDC). Methodology: An exploratory descriptive qualitative study using semi-structured interviews in English and Afrikaans was conducted with six purposively selected collectors, three patients who use collectors and three key informants who have intimate knowledge of the collectors and system at the health facility. Interviews were recorded, transcribed, translated into English (where applicable) and thematically coded to derive themes from the data. Ethical approval was provided by the University of the Western Cape Bio-Medical Research Ethics Committee and informed consent was obtained from all study participants. Results: Patients reported that their collectors exhibited positive characteristics such as trust, patience and reliability, as well as, a passion for helping the community and organisational skills. All patients acknowledged the benefits of utilising a collector and found them to be highly acceptable. Key informants, however, had some reservations about the characteristics of collectors and their role in medication distribution and were sceptical as to whether collectors were suitably equipped to perform this function. Patients were grateful when their collector had some knowledge about their condition and were able to converse with them regarding their medication. Key informants suggested that with sufficient training and skills development, collectors could potentially improve access to chronic medication parcels and impart basic knowledge about chronic medication adherence to patients. iv Conclusion: The collector system that has emerged at LRCDC is highly acceptable to patients, but health facility staff were more measured in their assessments. Health facility staff, however, acknowledged the potential of collectors to improve access to chronic medication parcels for patients with chronic conditions and the benefit of upskilling collectors to perform this function. Recommendations: As a short-term measure, collectors should be formally accepted at facilities as medicine agents. They should receive basic education about safe medication distribution practices. Patients should screen collectors to ensure that they have the desired positive attributes. Furthermore, future research is necessary to comprehensively understand the current scope of practice of collectors within communities

Thesis (M.Pharm) -- University of Limpopo, 2013 / Introduction: Many patients with chronic illnesses including asthma, hypertension, diabetes mellitus and HIV/AIDS, have difficulties adhering to their recommended regimens. This may result in sub-optimal management and control of the illness. What a patient understands about a specific regimen, including the reason for taking each medication and the intricacies of dosing schedules and administration requirements, can have a profound influence on adherence. Monitoring the effectiveness and safety of the treatment administered helps to decide whether this should be continued, changed or stopped. Any drug may produce unwanted or unexpected adverse reactions. The choice of drugs depends on many factors, such as the pattern of diseases, the treatment facilities, the training and experience of the available personnel, the financial resources available and demographic or environmental factors. The level of adherence to medication among with hypertension and diabetes mellitus or anti-retroviral therapy has not been studied in Limpopo province Aim: The aim of the study was to determine the adherence patterns and the factors contributing to the adherence to treatment by diabetic, hypertensive and HIV/AIDS patients at Mokopane Hospital. Methodology: This was a cross-sectional, descriptive study conducted through use of a questionnaire administered as an exit interview at the pharmacy after the patients had consulted the doctor and received their medication from the pharmacy. Results: The data was collected over a period of two months, where every patient was seen only once using their hospital numbers to avoid repetition. The study included a total of 307 participants, 201 (60%) were patients on ARVs, 48 (16%) were on anti-hypertensive, 35 (11%) on anti-diabetic, and 23 (8%) on both anti-hypertensive and anti-diabetics. The respondents were predominantly female (n = 234; 76%) while 73 (24%) male. Similarly of the 201 participants on ARVs treatment, 153 (76%) were females and 48 (24%) were males; among those on anti-hypertensives only 11 (22%) were males. For the diabetics 6 (17%) were males and 29 (83%) were females. Of participants with both hypertension and diabetes 9 (39.1%) were males and 14 (60.9%) were females. Seventy-nine percent (79%) of respondents on ART, 69% of those on anti-hypertensive, 72% of those on anti-diabetics, and 66% of those on both anti-diabetics and anti-hypertensives were adherent to their treatment. The younger patients (21 to 40 years) were less likely to have forgotten to take their treatment in the last one month (21% of respondents) than the older patients (41 to 87 years), 34% of whom forgot to take medication in the month prior to the study. Most respondents 250 (81%) reportedly used an alarm system/timer as reminder to take their medication. Most of them reported that they received information regarding their condition and medication, though some were not sure of the side effects or indications for the medications. Adherence was attributed to faith in the healthcare worker, fear of complications of the condition, and a desire to control the condition. Non-adherence was seen as an active decision, partly based on misunderstandings of the condition and general disapproval of medication which was only taken in order to facilitate daily life or minimize adverse effects. Conclusion: The levels of non-adherence (21% to 34%) among the patients on chronic medication are not acceptable. Elderly patients were more likely to be non-adherent to their treatment compared to the younger patients. Some information gaps were identified regarding their conditions and indications for medications. It is therefore important for the health professional to provide patients with full information about the indications, efficacy, and side effects of the medication given to them. Ways should be found to support elderly patients who are on chronic medications; for instance through directly observed therapy and/or using treatment supporters.

The human body best performs when it is physically active. The consequences of inactivity can bring about many health risks. The purpose of this study was to investigate the relationship between physical activity, waist circumference and medication use among South African men. Men between ages 30 and 65 years (N = 5000, ͞x = 43.2; ± 8.55) were included in this study. With the use of medication, distinction was drawn between various ethnic groups. Subjects selected for this study are members of the same medical aid. The respondents that formed part of a non-random availability population and participated voluntarily were used in this study. According to the results, it appears that out of a total of 4 954 respondents, 58.3% had the lowest incidence of physical activity, 21% were moderately active and 20.7% highly active. WC appears much higher among those that fall within the lowest incidence of physical activity group. No significant difference was observed between moderately and highly active people. There are 11 members in the high Physically Active (PA) category that has the highest WC (X =131.5). When scrutinising the different ethnic groups it is obvious that moderate to high PA is associated with a lower WC. Chronic medication (CM) use is determined on the basis of the registry for chronic medication use of the relevant medical aid. Those who participated in the assessment of waist circumference, CM and PA consisted of 4 964 respondents. In this study distinction was drawn between three medical condition influenced by exercise, namely diabetes, cholesterol and depression and hypertension. The results indicate that CM use is associated with higher WC and reduced kCal consumption. The majority of respondents (78%) do not use medication and 21.9% do. Those that do not use medication showed to have the lowest WC. However, respondents that are highly active and also use CM showed a lower MO than those that are low and moderately active. It can thus be deduced that regular physical activity is directly related to one’s health. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

The South African pharmaceutical market is seen as part of the so called "pharmerging" markets, together with countries like India, China and Brazil. These "pharmerging" markets are the fastest growing markets within the global pharmaceutical industry. The distribution of chronic medicine in South Africa is a growing market, as the disease burden in South Africa continues to escalate, with the incidence of chronic conditions growing at a rapid rate. The study will focus on one of South Africa’s pioneer courier medication service providers, with more than twenty years’ experience in the healthcare industry. The company will be referred to as Pharmacy X. The mission of Pharmacy X is to provide the right chronic medication, to the right patient, at the right place, at the right time. It is imperative to ensure that a patient receives his/her chronic medication on the scheduled date of delivery to ensure compliance and customer satisfaction. To achieve a competitive advantage, companies increasingly depend on their supply chain partners to minimize cost and improve business processes. The core value chain activity of outbound logistics has been outsourced by Pharmacy X to several courier companies. This study will aim to understand the importance of the outbound logistics function within the value chain of the company and the costs involved with the outsourcing of the function. The primary objective of this study was to determine the feasibility of an in-house courier operation in the Bloemfontein area versus the current outsourced courier model. In order to achieve the primary objective of the study, several secondary objectives were set and reached throughout the four chapters of this study. The study applied cost benefit analysis techniques to determine the feasibility of the Bloemfontein courier investment project. All the cost benefit analysis techniques concluded that the Bloemfontein courier investment will be a financial viable operation. The Bloemfontein courier investment will increase shareholder value over the period of the project compared to the current outsourced model. The contribution of this case study to determine the feasibility of a courier operation investment can be of value to Pharmacy X. The current projected total courier cost of Pharmacy X for the 2013 financial year amounts to more than a third of the total operational cost. The findings within the case study can lead to a greater national roll out of courier operations in order to reduce costs and increase profit margins for Pharmacy X. / MBA, North-West University, Potchefstroom Campus, 2014

The human body best performs when it is physically active. The consequences of inactivity can bring about many health risks. The purpose of this study was to investigate the relationship between physical activity, waist circumference and medication use among South African men. Men between ages 30 and 65 years (N = 5000, ͞x = 43.2; ± 8.55) were included in this study. With the use of medication, distinction was drawn between various ethnic groups. Subjects selected for this study are members of the same medical aid. The respondents that formed part of a non-random availability population and participated voluntarily were used in this study. According to the results, it appears that out of a total of 4 954 respondents, 58.3% had the lowest incidence of physical activity, 21% were moderately active and 20.7% highly active. WC appears much higher among those that fall within the lowest incidence of physical activity group. No significant difference was observed between moderately and highly active people. There are 11 members in the high Physically Active (PA) category that has the highest WC (X =131.5). When scrutinising the different ethnic groups it is obvious that moderate to high PA is associated with a lower WC. Chronic medication (CM) use is determined on the basis of the registry for chronic medication use of the relevant medical aid. Those who participated in the assessment of waist circumference, CM and PA consisted of 4 964 respondents. In this study distinction was drawn between three medical condition influenced by exercise, namely diabetes, cholesterol and depression and hypertension. The results indicate that CM use is associated with higher WC and reduced kCal consumption. The majority of respondents (78%) do not use medication and 21.9% do. Those that do not use medication showed to have the lowest WC. However, respondents that are highly active and also use CM showed a lower MO than those that are low and moderately active. It can thus be deduced that regular physical activity is directly related to one’s health. / Thesis (MSc (Biokinetics))--North-West University, Potchefstroom Campus, 2013.

The South African pharmaceutical market is seen as part of the so called "pharmerging" markets, together with countries like India, China and Brazil. These "pharmerging" markets are the fastest growing markets within the global pharmaceutical industry. The distribution of chronic medicine in South Africa is a growing market, as the disease burden in South Africa continues to escalate, with the incidence of chronic conditions growing at a rapid rate. The study will focus on one of South Africa’s pioneer courier medication service providers, with more than twenty years’ experience in the healthcare industry. The company will be referred to as Pharmacy X. The mission of Pharmacy X is to provide the right chronic medication, to the right patient, at the right place, at the right time. It is imperative to ensure that a patient receives his/her chronic medication on the scheduled date of delivery to ensure compliance and customer satisfaction. To achieve a competitive advantage, companies increasingly depend on their supply chain partners to minimize cost and improve business processes. The core value chain activity of outbound logistics has been outsourced by Pharmacy X to several courier companies. This study will aim to understand the importance of the outbound logistics function within the value chain of the company and the costs involved with the outsourcing of the function. The primary objective of this study was to determine the feasibility of an in-house courier operation in the Bloemfontein area versus the current outsourced courier model. In order to achieve the primary objective of the study, several secondary objectives were set and reached throughout the four chapters of this study. The study applied cost benefit analysis techniques to determine the feasibility of the Bloemfontein courier investment project. All the cost benefit analysis techniques concluded that the Bloemfontein courier investment will be a financial viable operation. The Bloemfontein courier investment will increase shareholder value over the period of the project compared to the current outsourced model. The contribution of this case study to determine the feasibility of a courier operation investment can be of value to Pharmacy X. The current projected total courier cost of Pharmacy X for the 2013 financial year amounts to more than a third of the total operational cost. The findings within the case study can lead to a greater national roll out of courier operations in order to reduce costs and increase profit margins for Pharmacy X. / MBA, North-West University, Potchefstroom Campus, 2014

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014