The adoption of the Lions Gate Hospital Drug Formulary by the British Columbia Hospital Association for distribution and use in all provincial hospitals endorses the growing trend toward regionalization of drug information. Several aspects of this Formulary were investigated in the present study with the objective of designing a text even more applicable to the varied needs of the province. The format of the Formulary and a mechanism for regularly evaluating and updating the information therein were the major areas receiving consideration. One major change in format proposed is the increase in the number of drug monographs to approximately 600 from the present 300 entries. This increase is based on the requests for additional drugs from the representative hospitals sampled in the province. Changes in the format of individual monographs include an expansion of information under the heading "Mode of Action", that an additional section on "Instructions to the Patient" be added to facilitate effective instructions for self-administration in ambulatory services, that each monograph receive a Canadian Drug Identification Code reference and that the information in each monograph be referenced where possible to the primary literature source. Changes in the format of the overall Formulary include a cross-index of monographs to manufacturers' brand names, a bibliography of the referenced information and a "Mini" Formulary format for use on individual hospital wards. The latter recommendation is made in recognition of the potential bulk of the overall Master Formulary which would make it awkward for efficient and frequent use. In this respect, it is anticipated that one Master Formulary containing all 600 eventual monographs, the bibliography for each and the various indices be made available in each hospital for resource reference. On each ward a complete Formulary of all drug monographs but not the accompanying bibliographies would be available. Studies showed that something less than 100 of these drugs (less than 20 percent) were used with any frequency on any specialty ward studied. Therefore, a "Mini" Formulary containing only the monographs of drugs frequently used in a specialty area would make the information more readily available in that service. Changes in printing format also are recommended with the objective of reducing the bulk of the proposed Formulary. A regular updating mechanism must be activated to keep the information in the Formulary current. Such a mechanism related to an annual literature evaluation assignment by the senior students of the Faculty of Pharmaceutical Sciences, University of British Columbia, is proposed. Based on this academic exercise, two types of updating are identified. First, a complete evaluation and referencing of the existing monograph information is required. Second, annual updating of this information from current literature should be maintained. To evaluate, revise and condense the students' evaluations to monograph format, a "service" component of faculty instructor time and of stenographer time have been projected. It is anticipated that the provision of approximately one-half time instructor per year and one-tenth time stenographer will be required on a "service" basis to enable the regular updating of the current Formulary as defined above. The arrangement for a Medical Review Board to review the evaluated monographs from a clinical validity standpoint also should be made. The above projections are based on studies related to the evaluation and updating of 100 drug monographs during 1972-73. A final recommendation is that the basis for generating, updating and additional referencing of the Drug Formulary should be a provincial Drug Information Centre. / Pharmaceutical Sciences, Faculty of / Graduate

The marketing of infant feeding products is almost impossible as the infant nutrition industry is highly regulated. Despite operating under strict regulations, the infant formula manufacturing companies still generate high revenues on an annual basis. The infant formula manufacturing industry operates under a value chain which can be broken down into six sequential steps. These steps are: (1) Translational science; (2) Product development; (3) Clinical research; (4) Product notification; (5) Reimbursement granting and (6) Product marketing. Medical nutrition companies aspire to understand product requirements of healthcare professionals and medical representatives. This is to enable direct investment to acquire market share without wasting resources. The medical nutrition industry currently makes use of medical representatives to execute product marketing. Manufacturing companies invest a lot of money into developing their products, employing and training medical representatives and trust that this will be enough to persuade healthcare professionals to recommend their products to parents. This study analyses the main contributing factors that enhance prescription of specialised infant formula by healthcare professionals. This study was conducted in a positivistic paradigm by making use of a quantitative approach. Healthcare professionals from Port Elizabeth, working with paediatric patients were included in this study. The healthcare professionals were chosen by a convenience sampling method and were then interviewed. The empirical interview results were substantiated with the interpretive findings which were in the form of verbatim statements extracted directly from the research questionnaire. Linkage between the dependable variable (prescription) and independent variables (manufacturing company; product composition; cost of product; medical representative and peers) were established and analysed. The research revealed that prescription behaviour is an important construct which can be measured in medical practices. Prescription behaviour is correlated with positive business and medical outcomes and manufacturing companies are able to exert influence over it through the identified variables. Of these variables, efficacy of vii a product, trusted manufacturing company and the medical representatives were found to have direct and significant effects. Healthcare professionals tend to prescribe a specialised infant formula if they have seen results and trust the outcome of the product. It is advisable for manufacturing companies to exert great effort before appointing a medical representative, to make sure that the right candidate represents the face of the company.

published_or_final_version / Orthopaedic Surgery / Master / Master of Philosophy

Marketing channels have traditionally been examined as commercial conduits the sale objective of which was to facilitate the flow of goods from producer to consumer. This approach emphasized functional and structural aspects of the channel and was primarily concerned with the efficiency of the distribution system. During the last two decades, marketing channels have increasingly been viewed as social systems affected by the behavioural dimensions of power, conflict, roles and communication. The rapid growth of vertical marketing systems with greater authority and interdependence between channel members, have stimulated interest in this field. Nevertheless, research has been limited and characterized by methodological problems and conceptual differences about the definitions of behavioural variables and their relationships. Some attempts have been made to develop an integrated framework within which to conduct research into channel relationships, but the validity and relaibility of these models has not been tested. This research project examined the relationship between the sources of conflict and stages in the conflict process. The sources of conflict were subdivided into attitudinal and structural categories, the latter being concerned with goal differences, the desire for autonomy in the face of interdependence and competition for scarce resources. The conflict process model adopted by the author assumes the existence of stages of latency, feeling, perception, manifestation and aftermath in each conflict episode. The first four were treated as separate behavioural states for which different levels of conflict intensity were measured. In order to provide greater explanatory power to the results of the analysis, the perceptions of two respondent groups were identified, namely the leader group, consisting of channel members responsible for the overall strategic interests of the channel, and the affected group, consisting of channel members who had been adversly affected by the activities of their partners in the channel dyad. In addition, respondents were asked to identify separately, their perceptions of the macro and micro levels of conflict in the four conflict states. The marketing channel for prescription medicines was selected for the study. The focal dyad consisted of retail pharmacy managers and doctors with single respondent perceptual measures being obtained from the retail pharmacy managers. A mail survey of all the retail pharmacy managers in South Africa, South West Africa/Namibia, and the independent homelands conducted in July 1987 resulted in a 40% response rate (1031 returns). Tests indicated statistically significant differences between the perceptual measures representing the sources and stages of conflict, the macro and micro levels of the stages of conflict and between the leader and the non-leader groups and the affected and non-affected groups. A sequential hierarchy in the level of conflict measured in the behavioural states was indicated, with decreasing levels of conflict being identified in states of latency, perception, feeling and manifestations, respectively. An analysis of the results revealed that attitudinal sources of conflict were more important that structural sources in measures of perceptions, feelings and manifestations of conflict behaviour. In the latent conflict state, structural sources assumed greater importance than attitudinal sources. In most of the measures, the sources of conflict were more correlated with perceptions of conflict at the macro level than the micro level. The exception was manifest conflict for which micro conflict levels were more important. The major sources of conflict were differences in perceptions, differences in goals and the lack of autonomy. The leader group indicated a particular concern for attitudinal factors, particularly communication difficulties. The affected group, whilst identifying attitudinal factors as being the most important, was especially concerned with their lack of autonomy from the doctor, rather than the competition for scarce resources which could have been expected. An overall assessment of the level of conflict between retail pharmacy managers and doctors indicated that the channel dyad was relatively free from conflict. Relationships were characterized by a degree of satisfaction, some degree of harmony and little evidence of conflict behaviour.

The primary purpose of this study is to analyze the formulary status of cephalosporins among a representative sample of hospitals in the United States. In addition, the research design attempts to determine the ranking of cephalsoporins in terms of acceptance to the hospitals' formulary and actual stocking of the cephaosoporin products. The study will attempt to ascertain the reasons for these rankings and the influence of DRG implementation, teaching status and hospital bed size on number of cephalosporins on formulary and in stock. This may yield insight into the strategies that hospitals are currently using to contain a significant proportion of their budget for pharmaceutical products