Magister Public Health - MPH / Background: South African medical scheme members needlessly purchase high cost originator prescription medicines which attract out of pocket co-payments at pharmacies. This is despite availability of low priced generic medicines that are paid for in full by medical schemes. Co-payments result from misalignment between prices of the dispensed medicine and that of the alternative medicine which appears on the medical scheme's formulary list and for which the scheme is prepared to pay for in full. To establish what factors caused such misalignment, perspectives of medical scheme members and key informants which included pharmacists, regulators and representatives of medical schemes were explored. The study focused on co-payments for prescription medicines dispensed at private sector retail pharmacies in Pretoria, South Africa. Aim: The aim of the study was to explore views about co-payments and identify factors that motivate and influence Pretoria medical scheme members to co-pay when purchasing prescription medicines at pharmacies, despite being insured by medical scheme insurance organizations. Methodology: An exploratory qualitative research study was performed. Semi-structured interviews were conducted among purposefully selected medical scheme members (12) and 9 key informants. Key informants consisted of dispensing pharmacists (6), regulators of health professionals and medical schemes (2) and a senior official (1) with experience in the regulation of medicines and operations within medical scheme organizations. From a total of twelve interviewed medical scheme members, eight were interviewed at preselected retail pharmacies after they had made a co-payment and the other four selected because they did not make a co-payment. To ensure diversity in views about co-payments and related factors, dispensing pharmacists, co-paying and non co-paying medical scheme members were accessed from six pharmacies that are located in two separate locations of different socioeconomic status in Pretoria, that is, the Pretoria East suburban area and Pretoria city centre which is close to Pretoria central station and taxi routes. Three pharmacies were identified from each of the two different geographical locations, one independent and two corporate pharmacies per socioeconomic area. One pharmacist was interviewed from each of the selected pharmacies and medical scheme members were accessed from across the six pharmacies. The remainder of the key informants such as the regulators, were interviewed during office hours at venues of their choice which included areas of work. A pilot study was conducted among medical scheme members and pharmacists to test the applicability of interview tools. All interviews were conducted face-to-face by the researcher and recorded. The electronic record was independently compared with the researcher's enhanced notes for data accuracy. Codes identified during data analysis were derived from the interview notes and recordings and translated into organized text for theme development in a manner that referenced them to each study objective. Themes were arrived at after combining similar codes which were noted as representing a particular description for use during data interpretation and report writing. Ethics: Ethical clearance was sought from the UWC Senate Research Committee and granted. Prior to conducting interviews, written consent was obtained from all participants. Research details were explained and also provided on the participant information sheet wherein voluntary participation was emphasized. Anonymity and confidentiality was maintained throughout. Results: All patients and pharmacists expressed confusion about the medical scheme rules and related co-payments. There were differing co-payment perspectives among scheme members depending on socioeconomic status, with affordability being a key factor among those of lower socio-economic status whilst convenience and lack of comprehensible information about co-payments was prioritised amongst those members of higher socioeconomic status. Key influences on patient's purchasing decisions were health professionals (both doctors and pharmacists), with friends, family members and advertisements less influential. Patients and medical schemes generally preferred to utilise large chain pharmacies and patients, in particular, had a poor perception of the quality of generics. In general, the first prescribed medicine was highly favoured by patients and this influenced medicine preferences during subsequent prescriptions, especially for non communicable disease (NCD) medicines. Pharmacists did not apply the generic substitution policy in a manner that benefited the consumer because the lowest priced generic was frequently not kept as pharmacy stock. Co-payments appeared to create a divide between corporate and independent pharmacies. Some regulators tended to blame patients, pharmacists and medical schemes rather than the lack of adequate enforcement of national policies and regulations. Inadequate monitoring and enforcement of pro-consumer policies were found to be the main factors that contributed to co-payments. Conclusions and Recommendations: The introduction of regulations on minimum requirements for stock available at private sector retail pharmacies should be considered to ensure availability of the lowest priced generic at all times. This would ensure that co-payments are reduced and the desired consumer benefits that should accrue from the existing generic substitution policy are realized and maximized. To prevent perception-based and self-initiated co-payment behavior among consumers, vigorous and continued education about the value and equivalence of generics should be championed at the highest level of government with the execution of this critical responsibility not left to those with profit driven motives. Consumers might benefit from extensive education about the purchasing choices made at pharmacies and, in particular, the negative financial consequences associated with choosing a preferred but highly priced originator versus a low cost generic medicine which is used to treat the same ailment. Enforcement of policies by dedicated government agencies could further protect consumers from preventable high cost of healthcare and of medicines in particular.

The purpose of this study was to determine the significance of certain factors relating to successful completion of the program by students in the Doctor of Education program at North Texas State University. Specifically, these factors were determined by a screening of judgments of North Texas State University graduates who had successfully completed the program, students engaged in the program, and from analysis of the factors derived from student records and research in related studies.

Background: Due to their abstract nature and lack of real-world application, theory development and testing are often difficult concepts for PhD students to embrace, especially within a virtual learning environment. Although experiential learning is a preferred method, there is a lack of evidence regarding its use in online PhD programs. Method: Four PhD nursing students enrolled in a Foundations of Theory course participated in an innovative experiential learning project designed to introduce the process of theory development and testing. Participants, led by a faculty-researcher, tested the applicability of a conceptual model using the Framework Method with the diary of a Holocaust survivor. Results: This experience increased the learners’ understanding and appreciation of theory development and testing processes as they relate to the nurse scientist’s role. Conclusion: Experiential learning in an online theory course is a viable option to promote learning, student engagement, and professional socialization.

No abstract / Mini Dissertation (MPhil)--University of Pretoria, 2019. / Public Law / MPhil / Unrestricted

The dissertation examines the significant yet neglected career of Yamei Kin, a Chinese woman whose transnational career influenced medicine and women’s rights in the United States and China. Although men dominated medicine, female doctors and nurses played an important role serving the poor and reaching women in China and Japan, where social norms restricted contact between the sexes. Thus, female medical professionals, represented by Yamei Kin, promoted the general welfare of the people, spread medical knowledge, and inspired more women to independence and excellence by their medical work. Yamei Kin is the first Chinese woman who obtained a medical degree in the United States (1885). A trailblazing physician, Kin broke the Chinese and Japanese prejudice against Western medicine and opened the medical profession to women in these two countries. She gave public lectures around America and England on women’s issues such as suffrage and prison reforms. She served as China correspondent of international women’s congress and shuttled among China, U.S. and Europe to improve women’s social status and promote the importance of women’s education. During World War I, she headed the research on soy food of the department of agriculture of the United States to study the potential of protein in soy and overcome a meat shortage during the war, enabling the public to maintain the same nutrition in their bodies even without meat.

The doctor-patient relationship is a very important aspect of a patient's health and wellbeing. It is a complex relationship that requires trust and understanding by both parties. Doctor shopping and changes in technology that allow patients to independently learn about their health have further complicated this relationship. This study looks at how participants perceive controlling language depending on the gender of the doctor. Participants were 339 University of Central Florida undergraduate students (112 men and 227 women, age M= 19.29, SD = 3.60) recruited through SONA. Participants first listened to a recording of a male or female doctor speaking to a patient using high or low level controlling language. They then answered questions about their opinion of the doctor, how they would behave in the patient's situation, and their beliefs about the role of doctors in the doctor-patient relationship. Results indicated both level of controlling language and doctor gender had significant effects on participants' perception of the doctor. Doctors who spoke with high level controlling language were seen as less helpful and supportive than doctors who spoke with low level controlling language. Participants also were less likely to recommend them to another person. Male doctors were seen as ruder than female doctors. These results suggest that doctors must communicate with each patient in that makes them both the most comfortable, and that male doctors may need to work harder to communicate empathy to their patients.

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