The dispensing Medical Practitioner has become topical since 13B4 . Dn this issue, much confusion and ignorance prevails, both amongst members of the medical and allied professions and in the public mind. This study was undertaken to demonstrate some aspects of dispensing of medicines in South Africa and to cansider the implications arising out of the application of legislation governing such dispensing of medicines by family practi tioners. The main objectives of this study were: CaD To identify and ascertain the opinions and policies of all those who are involved and concerned with the dispensing of medicines. Cb) To determine the implications of all the legislation governing the dispensing of medicines on: 1. patient care 2. the dispensing of medicines by doctors Cto their patients}. Information was gathered from a questionnaire sent to service/ consumer groups; from literature review of journals; publications and gazettes; and from legal consultations. The results of the study indicated that: C13 Professional Associations such as, Medical Association of South Africa, the Pharmaceutical Society as well as statutory bodies such as the South African Medical and Dental Council and the Pharmacy Council are concerned with issues such as 'trading in medicine ' and 'profiteering '. Inadequate patient care resulting from the physical, financial and economic hardships suffered by a majority of patients are issues which appear not to have been addressed by these bodies. CE) The fundamental issues of "what is in the best interest of the patient " appears to be ignored in legislation pertaining to dispensing. C33 Dispensing to patients became difficult due to the impractical stringent restrictions imposed by the legislation governing dispensing of medicines. C4D The dispensing of medicines by a doctor is less timB consuming, more convenient and cheaper for the patient as well as for the Sick Benefit Funds. The results were discussed with respect to their theoretical and practical implications and the conclusion reached was that the dispensing legislation presently designed for first world communities, became totally impractical when applied to third world communities, and that most doctors dispense medicines in response to the needs of the individual communities they service. Further research possibilities and recommendations were suggested in order to gain a greater understanding of the dispensing issue, which hopefully will assist to improve the quality of health care and also ensure the best possible advantage for the patient. / Thesis (MMed.)-University of Natal, Durban, 1986.

Submitted in fulfillment of the Masters degree in Technology: Community Health Nursing, Durban University of Technology, 2013. / Background One of the major challenges for the Department of Health in South Africa today is inequity and the need to provide quality integrated health care for all its citizens. Primary Health Care (PHC) has been declared as the way to achieve this goal, through the District Health System. Standard Treatment Guidelines (STGs) and the Essential Medicines List (EML) have been developed and are used at PHC clinics and hospitals. This study explored the use of STGs and the EML by professional nurses at PHC clinics in the UMgungundlovu District, KwaZulu-Natal, South Africa. Methods A quantitative descriptive research design was used. Questionnaires were used to collect data from respondents at the PHC clinics. A retrospective review of facility registers kept by the respondents on the rational use of drugs was also carried out by the researcher. Results The findings of the study revealed that the respondents had a good understanding of the use of the STGs and the EML. There was no evidence of polypharmacy, and medications were prescribed according to guidelines. Areas that were suboptimal were related to prescription writing in writing of schedules and routes of medication as indicated in facility records. The results further showed that training on the use of the STGs and EML were inadequate, which implies the need for strengthening of training programmes.

The Council of Australian Therapeutic Advisory Groups (CATAG) (2013) define a Pharmaceutical and Therapeutics Committee (PTC) as a ‘multi-disciplinary team committee with a commitment to the overall governance of the medicines management system in health service organizations to ensure the judicious, appropriate, safe, effective and cost-effective use of medicines’. The multi-disciplinary team includes the health care providers, who are actively participating in the health care systems, such as doctors, pharmacists, nurses, administrators, finance officers, quality improvement managers and other staff members who participate in the medicine use processes according to their knowledge and skills. The major role of this committee is to evaluate and promote rational drug use by health care providers and consumers. In addition, this committee is responsible for developing systems and strategies to prevent adverse medicine reactions and medication errors, enhance rational prescribing and dispensing, provide educational activities and ensure the use of quality and cost-effective medicines. This is a cross-sectional study that was aimed at exploring the structure, activities and functions of public sector institutional Pharmaceutical and Therapeutics Committees (PTC) in the Eastern Cape (EC) Province in South Africa (SA). The primary objectives of the study were to (i) investigate and describe the structure, functions and the activities of the institutional PTCs, and (ii) explore and describe the perception of PTC secretariats on the functionality of the institutional PTCs. A purpose-designed questionnaire including both quantitative and qualitative aspects adapted from other international studies was piloted prior to being used for data collection. The secretariats of the institutional PTCs were requested to complete the questionnaire. Data were analysed using descriptive statistics for the quantitative aspects and thematic analysis for the qualitative component of the questionnaire. Data collection commenced after approval by the relevant ethics committees had been granted. The findings of the study reflected that the majority of the PTCs in the EC province, SA are district/sub-district PTCs which are a cluster of a number of health care institutions in close proximity. The PTC members were appointed by the executive authority as recommended by the literature and other guiding documents. As expected the nurses were dominant as the members of the PTCs in these district/sub-district PTCs. The secretariats were the pharmacists where pharmacists were available and chairperson were doctors. These findings correspond to the recommendations by the National Department of Health PTC policy (2015) and the studies conducted in other countries. A number of PTCs had sub-committees formed e.g. ABC analysis review committee, medicine utilization evaluation (MUE) committee and pharmacovigilance committee to optimise their functionality. Out of 15 PTCs only five PTCs with sub-committees reported functions and interventions, establishment of policies and SOPs. The rest had no outcomes or interventions reported. Poor production of policies and SOPs was observed which differs from other countries’ PTCs. The focus of sub-committees in other countries is the development of formulary and policies related to medicine use. These findings pose a question regarding the functionality and effectiveness of the existing institutional PTCs in the province. In addition, the basic documents that are required to run the PTC were unavailable in a number of PTCs. Barriers to the functionality of PTCs were reported i) Lack of pharmacists and training in PTCs. ii) The rural nature of the EC province and iii) Unavailability of resources including lack of re-imbursement of personal costs. These findings reveal that budget allocation for institutional PTCs is crucial for their functionality. It can be concluded that in the EC province the institutional PTCs which are active and effective are low in number and do not cover all geographical areas. Secondly there is a need for training and educating the PTC members on the role of the PTC members, role of sub-committees, development of policies, SOPs and the basic documents for the functionality of the committee. It is also important that during training the monitoring and evaluation of the effectiveness of the committee is emphasised. Therefore, the choice of the PTC objectives should be measurable as they can assist as indicators of effectiveness. Support by the executive authority has been observed.

The development of essential medicines list is one of the main policies, globally accepted, for promoting rational drug use. Despite advances in developed countries, in countries like Brazil difficulties of establishing pharmacy and therapeutics committees, as well as the maintenance of its activities are characterized as a challenge for managers of health services. This study aimed to identify indicators, strategies for implementation and impact of policies on medicines selection in public hospitals. Through an approach of evaluative research in service work is divided into three steps: 1) Exploratory Phase (initial planning of the research and literature review), 2) Field Work Phase (institutionalizing the process of medicines selection in health services using the Situational and Strategic Planning - SSP), 3) Analysis of data (measurement and processing of data collected during the study). In this study, it was possible to perform an integrative literature review that results in 45 indicators for the evaluation of drug selection in health services and to construct optimal strategies for implementation of this activity in public hospitals through the SSP. The study culminated in analysis of economic-assistance impact, establishment of DTC and definition of essential medicine lists in public hospitals. / Uma das principais políticas mundialmente aceitas para a promoção do uso racional de medicamentos é o estabelecimento de listas de medicamentos essenciais. Apesar do avanço nos países desenvolvidos, em países como o Brasil as dificuldades de implantação de Comissões de Farmácia e Terapêutica, bem como a manutenção de suas atividades se caracterizam como um desafio para os gestores dos serviços de saúde. O presente estudo teve o objetivo de identificar indicadores, estratégias para a implantação e o impacto de políticas de seleção de medicamentos em hospitais públicos. Por meio de uma abordagem de pesquisa avaliativa em serviço, o trabalho se dividiu em três etapas: 1) Fase Exploratória (planejamento inicial da pesquisa e revisão da literatura); 2) Fase de Campo (institucionalização do processo de seleção de medicamentos nos serviços de saúde por meio do Planejamento Estratégico Situacional); 3) Fase de Análise dos Dados (aferição e tratamento dos dados coletados durante o estudo). Como resultado da revisão integrativa da literatura realizada, foi constituído um painel de 45 indicadores para avaliação da seleção de medicamentos. O estudo possibilitou ainda, verificar as etapas necessárias para implantação de uma política de medicamentos essenciais e os impactos na racionalização da lista de medicamentos em serviços do SUS. A institucionalização de uma política de medicamentos essenciais resultou em redução de 27,8% do quantitativo total de itens, aumento do percentual de itens com adequação à RENAME, Lista da OMS e Diretrizes Clínicas. Após a implantação das CFT, foi constatado também um menor percentual de medicamentos com patente na lista, aumento do percentual de genéricos e redução de aproximadamente 12% dos custos relacionados à lista nos hospitais avaliados.

Made available in DSpace on 2014-08-20T13:58:02Z (GMT). No. of bitstreams: 1 Tese ANDREA DAMASO BERTOLDI.pdf: 917303 bytes, checksum: 19c1b54f40d00e53bc200fe01be17bd0 (MD5) Previous issue date: 2006-06-21 / The utilization of medicines is an important indicator of health and well-being. In addition to its pharmacological role, medicines often assume a symbolic function. The access to medicines, particularly among low-income families, is an important health challenge, due to the high impact of expenditures with health, and specifically with medicines, on the family budget. The objective of this study was to evaluate medicine access and utilization in a population covered by the Family Health Program (PSF) in the city of Porto Alegre, Brazil. It was detected that 55% of the individuals interviewed (N=2988) used at least one medicine in the 15 days prior to the interview. Using the same recall period, only 4% of the subjects reported failing to use a needed medicine. Among the medicines used, 42% were purchased, 51% were provided for free by the PSF and 7% were obtained by other sources. Almost 90% of the medicines prescribed by PSF physicians were provided for free. Another focus of this thesis was to evaluate knowledge and utilization of generic drugs in a population-based sample of adults living in the city of Pelotas, Brazil. Only 4% of the medicines used were generics. Although the theoretical knowledge on generic drugs was satisfactory, almost half of the subjects incorrectly classified a similar medicine as generic in a simulation using pictures. This thesis also contains a literature review on methodologies applied in household studies on medicine utilization. Out of the 54 papers which fulfilled the review inclusion criteria, most were carried out in Europe or North America, used cross-sectional designs, collected data using interviewers, and requested the presentation of the packaging of the medicines used. The recall period of 15 days was the most frequently used. Data presented in this thesis allow us to conclude that the frequency of medicine use is high, although the utilization of generic drugs is very low, probably due to the existence of cheaper medicines in the market. The access to medicines in a population covered by the PSF in Porto Alegre was high in quantitative terms. / A utilização de medicamentos é um importante indicador de saúde e bem-estar. Além do seu papel farmacológico, o medicamento possui, muitas vezes, uma função simbólica. O acesso aos medicamentos, principalmente pelas parcelas mais pobres da população, é um importante desafio na área de saúde, tendo em vista o grande impacto dos gastos com saúde, e especificamente com medicamentos, no orçamento familiar. O objetivo do presente estudo foi avaliar o acesso aos medicamentos e sua utilização em uma população assistida pelo Programa Saúde da Família (PSF) na cidade de Porto Alegre. Constatou-se que 55% dos indivíduos entrevistados (N=2988) utilizaram pelo menos um medicamento nos 15 dias que antecederam a entrevista. Utilizando-se o mesmo período recordatório, apenas 4% dos indivíduos relataram ter deixado de usar algum medicamento que era necessário. Entre os medicamentos utilizados, 42% foram comprados, 51% foram distribuídos gratuitamente pelo PSF e 7% foram obtidos de outras formas. Quase 90% dos medicamentos prescritos por médicos do PSF foram fornecidos gratuitamente. Outro objeto de estudo desta tese foi avaliar o conhecimento e utilização de medicamentos genéricos em uma amostra populacional de adultos residentes na cidade de Pelotas, RS. Apenas 4% dos medicamentos utilizados pela população eram genéricos. Embora o conhecimento teórico sobre medicamentos genéricos tenha sido satisfatório, quase metade dos entrevistados confundiu um medicamento genérico com um similar em uma simulação utilizando fotografias. Esta tese também contém uma revisão da literatura sobre metodologias empregadas em estudos domiciliares sobre utilização de medicamentos. Entre os 54 artigos que preencheram os critérios de inclusão da revisão, a maioria foram realizados na Europa ou América do Norte, utilizaram delineamento transversal, coletaram dados com entrevistadores, e solicitaram a apresentação das embalagens dos medicamentos utilizados. O período recordatório utilizado com maior frequência foi o de 15 dias. Os dados desta tese permitem concluir que a frequência de uso de medicamentos é elevada, embora a utilização de medicamentos genéricos seja muito baixa, provavelmente pela existência de outros medicamentos mais baratos no mercado. O acesso aos medicamentos em uma população atendida pelo PSF em Porto Alegre foi alto em termos quantitativos.

劉鵬. / Thesis (doctoral)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (p. 450-498). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Liu Peng.

University of Macau / Faculty of Social Sciences. / Department of Government and Public Administration

INTRODUÇÃO:Os medicamentos pertencentes à RENAME têm sua eficácia comprovada são embasados sob critérios técnicos e científicos, e quando prescritos assumem profunda relevância dentro do contexto da saúde pública brasileira, por facilitarem o acesso aos medicamentos.OBJETIVO: Avaliar a associação entre acesso a medicamentos e prescrição segundo a Relação Nacional de Medicamentos Essenciais (RENAME). METODOLOGIA: Foram analisadas cópias de receitas médicas obtidas da pesquisa intitulada Experiência de Acesso da População de Baixa Renda a Medicamentos e Genéricos, Município de São Paulo 2005; para as análises estatísticas, foram utilizados os programas Epi-Info 2000 e OpenEpi. RESULTADOS: A média de medicamentos com receita foi de 2,5 / desvio padrão: 1,5479; o percentual de nenhum acesso e acesso parcial ás prescrições, juntos, foi de 54por cento ; nas Unidades Básicas de Saúde foram realizadas mais da metade das prescrições analisadas; a forma farmacêutica predominante foi comprimidos; cerca de 75por cento dos medicamentos estava presente nas listas de medicamentos essenciais, nacional ou municipal; dos medicamentos prescritos, 78por cento foram obtidos e 41por cento , dos que não estavam prescritos, também foram obtidos. CONCLUSÃO: Do total de medicamentos analisados, 65por cento estavam prescritos segundo a RENAME, e desses, 78por cento , foram obtidos; as Unidades Básicas de Saúde foram responsáveis por fornecer mais da metade das receitas; a quantidade de medicamentos prescritos mostrou-se negativamente correlacionada ao percentual de acesso aos mesmos; as prescrições quando seguem a RENAME têm a chance de acesso entre 4 a 6 vezes maior de se obter os medicamentos / INTRODUCTION: The medicaments belonging to RENAME have their eficiency verified, under technical and cientific criteria and when they are prescribed they become a matter of great concern regarding the Brazilian Publich Health because they facilitate the access to medicaments. OBJECTIVE: Evaluate the association between access to medicaments and prescription according the National List of Essential Medicaments (RENAME). METHODOLOGY : Copies of the medical prescriptions obtained from the research called Experience in Access to medicament and Generic of Low income population, Sao Paulo Municipal Discrict, 2005,and also the Programs Epi-Info 2000 and OpenEpi because of the statistic analysis. RESULTS: The average of medicament with prescription was 2,5 / Standard Deviation: 1.5479, the percentage of no access and partial access together was 54per cent. More than a half of the analysed prescriptions were done at the Health Fundamental Units. Also, among the pharmaceutical kinds, tablets and pills were the dominant ones and around 75per cent of the medicaments were present in the lists of essential medicaments in the country and districs. Among the prescribed medicaments, 78per cent were obtained while 41per cent of the non-prescribed ones were also obtained. CONCLUSION: From a total of the analysed medicaments, 65per cent of them were prescribed observing RENAME, and 78per cent of them were obtained. The Health Fundamental Units were responsible for providing more than a half of the prescriptions. The amount of medicaments involved were negatively correlated to the number of medicaments. The prescriptions that observe RENAME have 4 to 6 times more chances to be successful when it comes to obtaining medicines

University of Macau / Institute of Chinese Medical Sciences

Decisions to reform pharmaceutical policy often involve trade-offs between competing social and commercial goals. Canada's Access to Medicines Regime (CAMR), a reform that permits compulsory licensing for the production and export of medicines to developing countries, aimed to reconcile these goals. Since it was passed in 2004, only one order of antiretroviral drugs, enough for 21,000 HIV/AIDS patients in Rwanda for one year, has been exported. Future use of the regime appears unlikely. This research aimed to examine the politics underlying the formation of CAMR. Parliamentary committee hearing transcripts from CAMR's legislative development (2004) and from CAMR's legislative review (2007) were analyzed using a content analysis technique to identify how stakeholders who participated in the debates framed the issues. These findings were subsequently analyzed using a framework of framing, institutions and interests to determine how these three dimensions shaped CAMR's final policy design. In 2004, policy debates were dominated by two themes: intellectual property rights and TRIPS compliance. Promoting human rights and the impact of CAMR on innovation were hardly discussed. With the Departments of Industry Canada and International Trade as the lead institutions, the goals of protecting intellectual property and ensuring good trade relations with the United States appear to have taken priority over encouraging generic competition to achieve drug affordability. The result was a more limited interpretation of patent flexibilities under the WTO Paragraph 6 Decision. The most striking finding is the minimal discussion over the potential barriers developing country beneficiaries might face when attempting to use compulsory licensing, including their reluctance to use TRIPS flexibilities, their desire to pursue technological development and the constraints inherent in the WTO Paragraph 6 Decision. Instead, these issues were raised in 2007, which can be partly accounted for by a greater representation of the interests of potential beneficiary country governments. While the Government attempted to strike a balance between drug affordability and intellectual property protection, it designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access.