South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation. South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

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.

South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation. South African prescribers have a large choice of combination analgesic preparations available for prescribing. According to Desmeules et al. (2003:8) the advantages of combining analgesics include increasing the duration of analgesia, widening the spectrum of efficacy, improved patient compliance and reduced parenteral abuse potential. According to McMahon (1975:13) one of the principle arguments against fixed-dose combinations is that the physician surrenders flexibility in managing his patient. Combination analgesics may expose patients to ingredients not necessary for pain relief in their particular condition (Beaver, 1984). Rigas (1997:454) explains that the value of pharmaco-economics in providing cost-effective pharmacologic treatment for pain must not only be seen as a containment effort, but rather as a valuation effort. Meaningful economic analyses based on empiric information about cost and a range of subjective and objective outcomes are needed to minimise cost without compromising care. The objective of this study was to review and interpret the prescribing patterns of combination analgesics and the cost associated with their usage for the period 2001-2006 in a section of the private healthcare sector in South Africa. This research can be classified as a quantitative, retrospective drug utilisation review study. Data were obtained from a medicine claims database, and the study population consisted of all combination analgesic prescriptions (Mims® category 3.3) for the period 1 January 2001 to 31 December 2002 and 1 January 2004 to 31 December 2006. Prescribing Patterns of Combination Analgesics in the Private Health Care Sector. Firstly pain and the treatment thereof with combination analgesics were investigated from the literature to understand the disease and to determine the prevalence and treatment thereof. Secondly, managed health care, drug utilisation review, pharmacoeconomics and pharmaco-epidemiology were investigated from the literature to understand these concepts. The influence of the South African government on the medicine pricing regulations was discussed. Thirdly, through the empirical investigation the utilisation patterns of combination analgesics were reviewed, analysed and interpreted. It was determined that combination analgesic drugs represented 8.87% (n=261 907) of all medicine claimed during 2001 (N=2 951 326), decreased to 7.20% (n=381 809) during 2004 (N=5 305 846) after which it increased to 7.92% (n=187 745) in 2006 (N=2 370 572). Between 2001 (N=R379 708 489.00) and 2006 (N=R279 160 832.00) the cost percentage of the combination analgesic drugs decreased from 4.95% (n=R18 798 202.42) to 3.15% (n=R8 791 228.57). The average cost per combination analgesic drugs decreased from R71.77 ± 61.67 to R46.83 ± 43.41 between 2001 and 2006. This decrease was of no practical significance (d<0.8). The average number of combination analgesics per prescription stayed relatively constant varying between 1.01 ± 0.11 in 2001 and 1.02 ± 0.13 in 2006. The percentage generic combination analgesic drugs claimed increased from 29.63% (n=77 608) in 2001 to 66.37% (n=124 600) in 2006 (N=261 907 for 2001 and N=187 745 for 2006) even though generic medicine items claimed by the total database only increased from 26.79% (n=790 548) in 2001 to 40.27% (n=954 561) during 2006 (N=2 951 326 for 2001 and N=2 370 572 for 2006). The combination of ibuprofen 200mg, paracetamol 250mg and codeine phosphate 10mg (e.g. Myprodol® capsules, Mybulen® capsules, Gen-payne® capsules and Ibupain Forte® capsules) represented the active ingredient combination with the highest prevalence for the entire study period, increasing from 28.44% (n=74 483) in 2001 to 33.08% (n=62 100) in 2006 of all combination analgesics prescribed (N=261 907 for 2001 and N=187 745 for 2006). Generic substitution influenced the prevalence of the innovator medicine item, Myprodol® Capsules dramatically, causing a decrease from 23.16% (n=60 631) in 2001 to 3.77% (n=7 084) in 2006 representation of all combination analgesic prescribed. In 2006, the generics of Myprodol® Capsules e.g. Dentopain Forte®, Mybulen® Capsules, Gen-payne® and Ibupain Forte® represented 23.79% (n=44651) of all combination analgesics claimed. Recommendations were derived regarding certain aspects of the clinical and economical management of pain e.g. the implication of generic substitution with regard to cost and prescribing patterns, and the decreasing cost of combination analgesics which might encourage abuse, needs further investigation. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

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.

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.

Background: Warfarin is an anticoagulant that is used for the prophylactic and therapeutic treatment for a wide range of thrombo-embolic disorders. The prescribing and monitoring of warfarin therapy is challenging due to the fact that warfarin exhibits numerous interactions with other drugs and a variety of factors that influence the dosing of warfarin. Objective: The general objective of this study was to investigate the prevalence of drugs prescribed with warfarin that may have a potential drug-drug interaction (DDI) with warfarin. Methods: This was a cross-sectional, observational or qualitative study that was conducted on medicine claims data of a pharmaceutical benefit management company for patients receiving warfarin therapy for a six year period, ranging from 1 January 2005 to 31 December 2010. Drug products that were co-prescribed with warfarin were also identified from the medicine claims database. The total number of prescriptions for all drug products during the study period were analysed and compared to the warfarin dataset. This was done by means of the SAS 9.1® computer package (SAS Institute, 2004). The total number of prescriptions and medicine items claimed from the database during the study period were respectively 49 523 818 and 118 305 941. Potential DDls between warfarin and coprescribed drugs were identified and classified according to a clinically significant rating. The clinically significance ratings of potential DDls are described in three degrees of severity, identified as major, moderate and minor (Tatro, 2011 :xiv). Results: The database consisted of 427 238 warfarin prescriptions and 427 744 warfarin medicine items, which represented 0.9% of the total number of prescriptions and 0.4% of total number of medicine items. The total number of patients who claimed warfarin prescriptions through the database represented 0.9% (n=68 575) of the total number of patients who claimed prescriptions in the total database (2005-2010). General practitioners prescribed the highest frequency of warfarin medicine items, representing 58.3% (n=249 202) of the total number prescribed. The age group that claimed the highest frequency of warfarin prescriptions (n=327 592, 76.6%) and the highest frequency of warfarin medicine items (n=327 984, 76.7%) was age group 4 (consisting of patients 59 years and older). The distribution between females and males regarding warfarin prescriptions claimed (n=205 999, 48.2%; n=221 117, 51.8%) and warfarin medicine items claimed (n=206 232, 48.2%; n=221 390, 51.8%) were almost equal. General practitioners prescribed the highest average PDD (7.01 mg ± 9.86 mg) of warfarin medicine items. Paediatric cardiologists prescribed the lowest average PDD (4.61 mg ± 1.29 mg) of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDD between general practitioners and paediatric cardiologists. The average PDD of warfarin medicine items between females (6.60 mg ± 9.06 mg) and males (6.74 mg± 8.41 mg) was almost equal. The age group who was prescribed the highest average PDD was age group 2 (consisting of patients 20 years to 39 years old) (7.42 mg± 7.42 mg). Age group 4 (consisting of patients 59 years and older) (6.50 mg± 8.90 mg) was prescribed the lowest average PDD of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDDs of warfarin medicine items between these two age groups. The results revealed that drugs with a significance rating (SR) of 1 (n=155 066, 43.3%), 2 (n=30128, 8.4%), 4 (n=137144, 38.3%), and 5 (n=36144, 10.1%) were co-prescribed with warfarin in the six year study period. The five drugs that was co-prescribed with warfarin most frequently was aspirin (n=48 903, 13.6%), thyroxine (n=33 954, 9.5%), amiodarone (n=25 056, 7.0%), simvastatin (n=19 070, 5.3%) and celecoxib (n=10 794, 3.0%). These five drugs have a SR of 1. Conclusions: This study showed that the top five drugs most frequently prescribed with warfarin are aspirin, thyroxine, amiodarone, simvastatin and celecoxib. These drugs can potentially interact with warfarin. The potential interactions of these drugs are rated with a significance rating of 1. This concludes that drugs that can potentially cause life threatening effects and permanent damage are commonly co-prescribed with warfarin. Clinical data concerning the INR or PT must be obtained in order to evaluate whether or not warfarin therapy is changed when a potentially interacting drug is co-prescribed. The age of the patients as well as the duration of warfarin treatment should also be obtained in order to assess whether warfarin treatment is changed with the progression of age. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2013

Background: Warfarin is an anticoagulant that is used for the prophylactic and therapeutic treatment for a wide range of thrombo-embolic disorders. The prescribing and monitoring of warfarin therapy is challenging due to the fact that warfarin exhibits numerous interactions with other drugs and a variety of factors that influence the dosing of warfarin. Objective: The general objective of this study was to investigate the prevalence of drugs prescribed with warfarin that may have a potential drug-drug interaction (DDI) with warfarin. Methods: This was a cross-sectional, observational or qualitative study that was conducted on medicine claims data of a pharmaceutical benefit management company for patients receiving warfarin therapy for a six year period, ranging from 1 January 2005 to 31 December 2010. Drug products that were co-prescribed with warfarin were also identified from the medicine claims database. The total number of prescriptions for all drug products during the study period were analysed and compared to the warfarin dataset. This was done by means of the SAS 9.1® computer package (SAS Institute, 2004). The total number of prescriptions and medicine items claimed from the database during the study period were respectively 49 523 818 and 118 305 941. Potential DDls between warfarin and coprescribed drugs were identified and classified according to a clinically significant rating. The clinically significance ratings of potential DDls are described in three degrees of severity, identified as major, moderate and minor (Tatro, 2011 :xiv). Results: The database consisted of 427 238 warfarin prescriptions and 427 744 warfarin medicine items, which represented 0.9% of the total number of prescriptions and 0.4% of total number of medicine items. The total number of patients who claimed warfarin prescriptions through the database represented 0.9% (n=68 575) of the total number of patients who claimed prescriptions in the total database (2005-2010). General practitioners prescribed the highest frequency of warfarin medicine items, representing 58.3% (n=249 202) of the total number prescribed. The age group that claimed the highest frequency of warfarin prescriptions (n=327 592, 76.6%) and the highest frequency of warfarin medicine items (n=327 984, 76.7%) was age group 4 (consisting of patients 59 years and older). The distribution between females and males regarding warfarin prescriptions claimed (n=205 999, 48.2%; n=221 117, 51.8%) and warfarin medicine items claimed (n=206 232, 48.2%; n=221 390, 51.8%) were almost equal. General practitioners prescribed the highest average PDD (7.01 mg ± 9.86 mg) of warfarin medicine items. Paediatric cardiologists prescribed the lowest average PDD (4.61 mg ± 1.29 mg) of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDD between general practitioners and paediatric cardiologists. The average PDD of warfarin medicine items between females (6.60 mg ± 9.06 mg) and males (6.74 mg± 8.41 mg) was almost equal. The age group who was prescribed the highest average PDD was age group 2 (consisting of patients 20 years to 39 years old) (7.42 mg± 7.42 mg). Age group 4 (consisting of patients 59 years and older) (6.50 mg± 8.90 mg) was prescribed the lowest average PDD of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDDs of warfarin medicine items between these two age groups. The results revealed that drugs with a significance rating (SR) of 1 (n=155 066, 43.3%), 2 (n=30128, 8.4%), 4 (n=137144, 38.3%), and 5 (n=36144, 10.1%) were co-prescribed with warfarin in the six year study period. The five drugs that was co-prescribed with warfarin most frequently was aspirin (n=48 903, 13.6%), thyroxine (n=33 954, 9.5%), amiodarone (n=25 056, 7.0%), simvastatin (n=19 070, 5.3%) and celecoxib (n=10 794, 3.0%). These five drugs have a SR of 1. Conclusions: This study showed that the top five drugs most frequently prescribed with warfarin are aspirin, thyroxine, amiodarone, simvastatin and celecoxib. These drugs can potentially interact with warfarin. The potential interactions of these drugs are rated with a significance rating of 1. This concludes that drugs that can potentially cause life threatening effects and permanent damage are commonly co-prescribed with warfarin. Clinical data concerning the INR or PT must be obtained in order to evaluate whether or not warfarin therapy is changed when a potentially interacting drug is co-prescribed. The age of the patients as well as the duration of warfarin treatment should also be obtained in order to assess whether warfarin treatment is changed with the progression of age. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2013

Background: According to the United Nations AIDS Reference Group (2010) and World Health Organization (2010:2), approximately 33 million people in the world had HIV/AIDS in 2009 of which 2.6 million were children. More than 30 million of these individuals resided in low– and middle–income countries. South–Africa had the highest prevalence of HIV/AIDS in the world with an estimated 5.2 million patients in 2009 (Statistics South Africa, 2010:2). Although the prevalence of human immunodeficiency virus (HIV) infection among children is reported to be high, little is known about other medication administrated concomitantly with their antiretroviral drugs. Objective: The general objective of this study was to investigate possible changes in the medicine prescribing patterns of HIV/AIDS and non–HIV/AIDS children. Methods: A quantitative, retrospective drug utilisation review was performed utilising medicine claims data of a South African pharmacy benefit management company. Data for a four–year period (Jan 1, 2005 to Dec 31, 2008) were analysed. The study population consisted of all children <=12 years divided into those receiving ARVs (designated HIV positive) and those without (designated HIV negative). Descriptive statistics such as average mean, standard deviation, t–test, d–values, and two way frequency tables were used to describe the results. Data were analysed using the Statistical Analysis System ® SAS 9.1 ® programme. Results: The study population (children <= 12 years) represented 16.2% (n = 197 323) of the total population in 2005, 15.4% (n = 193 346) in 2006, 15.6% (n = 142 049) in 2007 and 13.3% (n = 98 939) in 2008. Children with HIV/AIDS represented 0.2% (n = 197 323) of the study population in 2005 and increased to 0.4% (n = 98 939) in 2008, whereas the percentage of children without HIV/AIDS decreased from 99.8% (n = 197 323) in 2005 to 99.6% (n = 98 939) in 2008. The total number of HIV/AIDS children that also received other medication concomitantly with their ARVs increased from 96.5% (n = 402) in 2005 to 97.2% (n = 427) in 2008. Males with HIV/AIDS who used other medication represented 52.6% (n = 388) in 2005 and increased to 53.3% in 2008 while female HIV/AIDS patients represented 47.4% in 2005 and decreased to 46.7% in 2008. Prescriptions containing three ARV items represented 69.5% (n = 2 969) of the total number of prescriptions received by HIV/AIDS patients in 2005 and decreased to 67.7% in 2008. The combination of lamivudine, nevirapine and stavudine were the three products that appeared most frequently on prescriptions for HIV/AIDS children in the age group 0 <= 1 years and 1 <= 5 years from 2005 to 2008. In the age group 5 <= 12 years the combination most frequently prescribed was lamivudine, nevirapine and zidovudine. HIV positive children received 6.2 ± 4.62 prescriptions for other medication (non–ARVs) per year during 2005 compared to HIV negative children with 3.9 ± 3.71 (p < 0.0001, d = 0.5). In 2008 HIV positive children received 6.4 ± 5.02 prescriptions per year compared to HIV negative patients who received 4.36 ± 4.05 prescriptions (p < 0.0001, d = 0.5) in 2008. HIV negative children received more central nervous system items, endocrine items and autacoids than HIV positive children, whereas HIV positive children received more respiratory system agents, dermatological, ear, nose throat and antimicrobials items. Conclusion: The study showed that HIV positive children received significantly more prescriptions for other medication per year compared to their HIV negative counterparts. The top pharmacological groups mostly prescribed to both groups were respiratory agents, antimicrobials, analgesics, dermatological and ear, nose and throat items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.

Background: According to the United Nations AIDS Reference Group (2010) and World Health Organization (2010:2), approximately 33 million people in the world had HIV/AIDS in 2009 of which 2.6 million were children. More than 30 million of these individuals resided in low– and middle–income countries. South–Africa had the highest prevalence of HIV/AIDS in the world with an estimated 5.2 million patients in 2009 (Statistics South Africa, 2010:2). Although the prevalence of human immunodeficiency virus (HIV) infection among children is reported to be high, little is known about other medication administrated concomitantly with their antiretroviral drugs. Objective: The general objective of this study was to investigate possible changes in the medicine prescribing patterns of HIV/AIDS and non–HIV/AIDS children. Methods: A quantitative, retrospective drug utilisation review was performed utilising medicine claims data of a South African pharmacy benefit management company. Data for a four–year period (Jan 1, 2005 to Dec 31, 2008) were analysed. The study population consisted of all children <=12 years divided into those receiving ARVs (designated HIV positive) and those without (designated HIV negative). Descriptive statistics such as average mean, standard deviation, t–test, d–values, and two way frequency tables were used to describe the results. Data were analysed using the Statistical Analysis System ® SAS 9.1 ® programme. Results: The study population (children <= 12 years) represented 16.2% (n = 197 323) of the total population in 2005, 15.4% (n = 193 346) in 2006, 15.6% (n = 142 049) in 2007 and 13.3% (n = 98 939) in 2008. Children with HIV/AIDS represented 0.2% (n = 197 323) of the study population in 2005 and increased to 0.4% (n = 98 939) in 2008, whereas the percentage of children without HIV/AIDS decreased from 99.8% (n = 197 323) in 2005 to 99.6% (n = 98 939) in 2008. The total number of HIV/AIDS children that also received other medication concomitantly with their ARVs increased from 96.5% (n = 402) in 2005 to 97.2% (n = 427) in 2008. Males with HIV/AIDS who used other medication represented 52.6% (n = 388) in 2005 and increased to 53.3% in 2008 while female HIV/AIDS patients represented 47.4% in 2005 and decreased to 46.7% in 2008. Prescriptions containing three ARV items represented 69.5% (n = 2 969) of the total number of prescriptions received by HIV/AIDS patients in 2005 and decreased to 67.7% in 2008. The combination of lamivudine, nevirapine and stavudine were the three products that appeared most frequently on prescriptions for HIV/AIDS children in the age group 0 <= 1 years and 1 <= 5 years from 2005 to 2008. In the age group 5 <= 12 years the combination most frequently prescribed was lamivudine, nevirapine and zidovudine. HIV positive children received 6.2 ± 4.62 prescriptions for other medication (non–ARVs) per year during 2005 compared to HIV negative children with 3.9 ± 3.71 (p < 0.0001, d = 0.5). In 2008 HIV positive children received 6.4 ± 5.02 prescriptions per year compared to HIV negative patients who received 4.36 ± 4.05 prescriptions (p < 0.0001, d = 0.5) in 2008. HIV negative children received more central nervous system items, endocrine items and autacoids than HIV positive children, whereas HIV positive children received more respiratory system agents, dermatological, ear, nose throat and antimicrobials items. Conclusion: The study showed that HIV positive children received significantly more prescriptions for other medication per year compared to their HIV negative counterparts. The top pharmacological groups mostly prescribed to both groups were respiratory agents, antimicrobials, analgesics, dermatological and ear, nose and throat items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.