The general aim of this study was to investigate the prescribing patterns of products that contain methylphenidate or atomoxetine in a section of the private health care sector of South Africa. A quantitative, retrospective drug uitilisation review was performed according to data obtained from the database of a South African medicine claims pharmacy benefit management company's for three consecutive study years (Le. 2005 to 2007). The results indicated that a total of 7,990 patients had been prescribed products that contained methylphenidate or atomoxetine in 2005. The total for 2006 was 8,575 and it decreased to a total of 7,828 in 2007. Of all the patients who received the mentioned products, the percentage for females increased from 27.75% (N = 7,990) in 2005 to 29.06% (N =7,828) in 2007. With regard to the same products the percentage for males decreased from 72.03% (N = 7,990) in 2005 to 70.89% (N = 7,828) in 2007. The ratio for the gender-related prescribing patterns of medicine items that contained methylphenidate or atomoxetine in this section of the private health care sector of South Africa was ± 2.55:1 for males to females in comparison with the international male:female ratio of 3:1. According to the medicine claims on the database for 2005 the total number of prescriptions that indicated products containing methylphenidate or atomoxetine was calculated as 8,522, 798 (i.e. N = 8, 522,798) or as a percentage of 0.32% prescriptions. The percentage showed an increase to 0.41 % in 2007 (N = 8,015,538). Of all the medicine items containing methylphenidate or atomoxetine those products that contained atomoxetine represented 4.69% and those that contained methylphenidate represented 95.31%. In 2005 the average cost per prescription that indicated items containing methylphenidate or atomoxetine amounted to R318.29 ± R162.09. In 2007 the amount increased to R358.91 ± R208.10. The percentage of children younger than five years of age, and who had been prescribed products containing methylphenidate or atomoxetine, increased from 0.91 % in 2005 (N = 7,990) to 1.11 % in 2007 (N =7,828). The percentage for children aged 5 to 12 years decreased from 53.62% in 2005 to 49.23% in 2007. For adolescents the percentage increased from 26.32% in 2005 to 27.35% in 2007. The same pattern repeated itself in the case of adults (age 18+ years). Among the top trade name products prescribed were Ritalin LA 20mg®, Ritalin 20mg®, Concerta 36mg®, Ritalin LA 30mg® and Concerta 18mg®. Possible drug-drug interactions were found between products containing methylphenidate or atomoxetine and products containing imipramine, amitriptyline and carbamazepine. Findings indicated that the number of products containing methylphenidate or atomoxetine increased from 2005 to 2007, while also revealing that those products containing methylphenidate remained in the majority. The average costs of products containing methylphenidate or atomoxetine increased from 2005 to 2007. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.

Magister Pharmaceuticae - MPharm / Efforts to improve the quality of service delivery are an ongoing feature in different organisations. In the private health care sector, particularly pharmaceutical services in private hospitals, such efforts are important because of the sector’s commercial nature. This stems from the fact that customers pay a lot of money for services and expect services that are worth the money they pay. A private health care delivery group encourages such efforts in pharmacies of its hospitals through scientific research.Service providers and consumers were engaged to gain an appreciation of quality service delivery. The qualitative research method was used for the reason that it is scientific research that seeks to provide understanding and insight into social experiences as appreciated by the people involved and that it is a process of disciplined investigation that is methodical and verifiable.The research project was conducted to identify factors that influence pharmaceutical service delivery, to establish the understanding of quality pharmaceutical service delivery and establish the expectations of customers regarding pharmaceutical service rendered in a private hospital group.

A dissertação trata do acesso aos serviços de alta complexidade, particularmente os exames diagnósticos e complementares, estudado entre usuários de planos de saúde privados que buscam atendimento e diagnóstico especializado. Desde a década de 80 o usuário do sistema público de saúde vem procurando a saúde suplementar. Contudo, afirmar que o acesso é garantido no domínio privado, através da contratação dos planos de saúde, é uma incerteza que rodeia a inspiração para esta pesquisa, que se justifica pela relevância de ações que possibilitem a melhora da qualidade regulatória dos planos de saúde, a partir do controle social de seus usuários. O objetivo geral é analisar as percepções do acesso aos exames de alta complexidade nos serviços de saúde privados entre usuários de planos de saúde. Os objetivos específicos são descrever as percepções dos usuários de planos de saúde acerca do acesso aos exames de alta complexidade; analisar as motivações dos usuários de planos de saúde privados para a realização de exames de alta complexidade através da rede privada de assistência; e analisar o nível de satisfação dos usuários de planos de saúde quanto ao acesso aos exames de alta complexidade. A metodologia é qualitativa-descritiva, onde a amostra foi de trinta usuários de planos de saúde, acima de 18 anos, selecionados no campo de estudo no ano de 2010. O cenário de estudo foi um laboratório privado de medicina diagnóstica no Rio de Janeiro. As técnicas de coleta de dados utilizadas foram formulário e entrevista individual estruturada. A análise do formulário foi realizada através de estatística descritiva, e as entrevistas através da análise de conteúdo temática-categorial. Os usuários de plano de saúde declararam que o acesso é garantido com facilidade para os exames de alta complexidade. Suas principais motivações para a realização desses exames na rede privada de assistência foram caracterizadas pela rapidez de atendimento, flexibilidade e facilidade de marcação pela internet, telefone ou pessoalmente no laboratório estudado, pronta entrega dos resultados, dificuldade e morosidade do atendimento do SUS, localização do prestador credenciado próxima de bairros residenciais ou do trabalho, resolutividade diagnóstica de imagem de excelência, possibilidade de escolha pelo usuário entre as modalidades aberta e fechada de ressonância magnética e tomografia computadorizada, além da densitometria óssea que foram facilmente acessíveis a todos os sujeitos da pesquisa. O nível de satisfação foi correspondido com a rapidez na realização dos exames em caráter eletivo e de urgência quase equiparados na escala de tempo de acordo com os usuários. Contudo, embora as notas de avaliação dos usuários quanto aos seus planos de saúde tenham sido altas, foram abordadas algumas dificuldades, tais como: prazos de validade dos pedidos médicos com datação prévia; solicitações de senhas de autorização pela operadora; burocracia nos procedimentos de agendamento; dificuldades de acesso para tratamentos como implantes, fisioterapia, RPG, pilates, home care, consultas de check up; negação de reembolsos; restrição de materiais cirúrgicos, em especial as próteses e órteses; e restrições específicas de grau para cirurgias de miopia. Conclui-se que o atendimento rápido dos exames de imagem de alto custo na amostra foi descrito como satisfatório, embora a percepção de rapidez possa variar em função do tipo de produto do plano de saúde privado contratado, com necessidade de melhoria regulatória em alguns aspectos pontuais da saúde suplementar. / This dissertation deals with access to services of high complexity, particularly diagnostic and complementary exams between users of private health system that seek specialized treatment and diagnosis care. Since the 80's people has being looking for additional health system. However, say that access is guaranteed in the private system, is an uncertainty that leads the inspiration for this research, which is justified by the importance of actions that enable the improvement of regulatory quality of health plans from social control of its users. The overall objective is to analyze the perceptions to access high complexity exams in the health system between users of private health plans. The specific objectives are to describe the perceptions of users of health plans to access high complexity exams; analyze motivations from users of private health plans for the exams of high complexity through the private network; and analyze the level of users satisfaction with health plans regarding access to tests of high complexity. The methodology is qualitative-descriptive, and the sample was thirty users of private health care system greater than 18 years, selected in 2010. The research scenario was a private laboratory of medical diagnostic in Rio de Janeiro. Data collection techniques used were individual interviews and structured form. The analysis was performed by the form of descriptive statistics, and interviews through the analysis of thematic content-category. Users of health plan stated that the access is guaranteed with facility for tests of high complexity. Their main motivations for doing exams in private health care services were characterized by quick responsiveness, flexibility and ease of marking their exams by internet, telephone or personally in the laboratory, prompt delivery of results, difficulty and length of service in SUS, location of laboratory near home or work, excellence resolution in diagnostic image, user choice between open and closed methods of magnetic resonance and computed tomography, and bone densitometry were easily accessible to all research subjects. Satisfaction level was reached by quickly resolution of the exams, and performing elective and emergency procedures in almost similar time scale, according to users. However, although evaluation from users with their health plans have been high, some difficulties were pointed such as validity periods for realization of exams; according to the date on the medical application; password requests for authorization by the operator; bureaucracy in procedures for scheduling exams; and poor access to treatments such as implants; physiotherapy; RPG; pilates; homecare; check ups; denied refunds; restricted surgical materials; in particular prosthetics and orthotics; and specifics degree limitation for myopia surgery. We conclude that the quickly response of high complexity exams were described as satisfactory, although the perception of speed may vary depending on the type of private health plans contracted, with the need for regulatory improvement in specific points in privete health system.

Magister Public Health - MPH / The development and provision of equitable and acceptable standard of health services to all segments of the population has been the major objective of the 1993 Ethiopian National health policy. However, community based studies on satisfaction with public health care facilities reveal that the majority of the population are not satisfied with the services provided predominantly as a result of the long waiting times. Studies done on private health facilities on the contrary reveal that patients are satisfied with the service delivered within short waiting times in these clinics. Even though the speculated waiting time is thought to be long among the public health care facilities and short in private clinics, the actual waiting and service times have not been measured and compared. Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of 'acceptable' waiting time among the providers and clients. Materials and methods: A cross sectional observational study using quantitative techniques was carried out amongst patients and staff at selected public and private health care facilities in Gondar District. Stratified sampling method was used to select facilities. All patients visiting the selected facilities and all staff who provided service to patients on the day of the study were included in the time-delimited sample. Data was collected by research assistants and health workers from all patients attending the health care facility by registering the arrival and departure time of each patient to the facility and to each service point on a patient flow card. Then data was cleaned and captured by a specific Waiting and Service Time database. Descriptive statistics was done on waiting and service times for each facility and this was summarized for each public and private health facility by using tables and graphs. Finally a comparison was made for private and public health facilities by using Wilcoxon-mann-whitney non parametric tests. / South Africa

Magister Public Health - MPH / Aim: To determine the waiting and service times among the public and private health care facilities and measure the perceptions of “acceptable” waiting time among the providers and clients.

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The aim of the study was to analyze quality of investigation and treatment in the specialized services – dermatological and sexually transmissible diseases outpatient department of the II Kaunas Clinical hospital and private health care institution “Medidermas”. Methods. Study population – patients with dermatological and sexually transmissible diseases. Randomly selected patients were interviewed in 2004 September-October. Totally 157 patients from state and 62 from private institution were investigated. MS Office Exel and EpiInfo 6.0 packages were used in the statistical analysis. Results. Mean age of the investigated was 42.5±1.1 yrs. One quarter of the investigated chose health care institution, recommended by familiar or friend, only 24% applied to specialized departments with referrals. The majority of respondents (85.5%) of the private institution “Medidermas” were accepted after few days of registration, 38.2% (p<0.001) of the dermatological and sexually transmissible diseases outpatient department of the II Kaunas Clinical hospital were accepted after one or two weeks. 45.2% of the investigated in the private service were registered in the interval of 10 minutes, 43.5% - 15 minutes. In the state institution only 17.8% (p 0.001) were registered during 10 minutes and half – 15 minutes. The respondents of “Medidermas” had a longer waiting time before acceptance to a medical doctor as compared to the state health care service (in 10 minutes 41.9% and 17.3%, p<0.001... [to full text]

Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

Due to the fact that the function of dispensing is not the exclusive practice of a single profession, there is much conflict surrounding the issue: it forms the crux of the pharmacy profession but it also forms part of doctors’ scope of practice. Separation of the acts of prescribing and dispensing would prevent the interest of the doctor, who has the potential to profit from selling medicines, being placed above the interest of the patient. It would, however, also affect the essential services that many dispensing doctors provide to pensioners, unemployed patients, those not covered by a medical scheme and those in rural areas. The implications of doctor dispensing are not clear as conflicting evidence suggests that dispensing doctors prescribe more medicine items, injections and antibiotics while preferring certain brand names on the one hand but on the other, evidence shows that dispensing doctors dispensed less expensive medicines compared to other health care providers. The main objective of this study was to analyse the prescribing patterns of dispensing doctors and other medicine providers in a section of the private health care sector of South Africa for 2005 to 2008 by using a medicine claims database. A retrospective drug utilisation review was conducted by extracting data from a medicine claims database for a four–year period, from 1 January 2005 to 31 December 2008. The results revealed that dispensing doctors had a lower cost per prescription compared to other health care providers (R112.66 ± R4.45 vs. R258.48 ± R23.93) and also had a lower cost per medicine item (R39.62 ± R2.18 vs. R112.43 ± R7.56) for the entire study period from 2005 to 2008. Dispensing doctors provided more items per prescription compared to other health care providers (2.85 ± 0.05 items vs. 2.30 ± 0.06 items) but other health care providers claimed more prescriptions per patient per year (7.50 ± 1.15 prescriptions vs. 3.29 ± 0.07 prescriptions). A higher percentage of generic medicine items were provided to patients visiting dispensing doctors. Dispensing doctors treated a majority of patients aged above 19 to 44 years of age while other health care providers treated a majority of patients above 59 years of age. Both dispensing doctors and other health care providers treated a majority of female patients and issued a majority of medicine items to treat acute conditions. The results also revealed that dispensing doctors generally provided relatively inexpensive medicine items, including generic and innovator items, for female and male patients of all ages while other health care providers showed the opposite trend and issued relatively expensive medicine items to these patients. However, when analysing the top twelve pharmacological groups claimed, dispensing doctors had relatively higher costs compared to other health care providers for nine of the pharmacological groups (central nervous system, analgesic, cardio–vascular, ear, nose and throat, dermatological, urinary system, antimicrobial, endocrine system and cytostatic). The pharmacological groups contributing to the highest number of medicine items and highest medicine cost contribution were the antimicrobial group for dispensing doctors and cardio–vascular group for other health care providers. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.