Prescribing patterns for Parkinson’s disease in a South African patient population.

The primary aim of the study was to analyse the treatment of Parkinson’s disease in a defined patient population in South Africa. A cross-sectional, retrospective drug utilization study was conducted on prescription data of a national community pharmacy group for 2010. A total of 25 523 products were prescribed to 5 168 patients. Most patients (59.17%) were females. The average age of patients was 69.57±10.37 years. Levodopa-containing products constituted 46.50% of prescribing frequency. The highest sales value was attributed to a generic levodopa/carbidopa 100/25mg preparation, with the second being the innovator product of the same strength. Dopamine agonists (pramipexole and ropinirole) constituted 39.80% of prescribing frequency, followed by anticholinergic agents (9.20%), the MAO-B inhibitor selegiline (2.12%) and amantadine (1.80%). The cost of levodopa products in combination with a dopa decarboxylase inhibitor was 45.00% of the total expenditure on antiparkinsonian medication. Levodopa remained the gold standard for the treatment of Parkinson’s disease. Further investigations need to focus on dosages, side effects, compliance and continuity of medication.

The Phelophepa Health Care Train: a Pharmacoepidemiological Overview of the Western Cape in 2009

Background: The Phelophepa Health Care Train is the only primary healthcare train in the world. Phelophepa is an innovative initiative that attempts to make a positive difference to primary healthcare in rural South Africa. The primary aim of this study was to determine the epidemiological and prescribing statistics for Phelophepa during the period that the train was stationed in the Western Cape in 2009. Methods: Phelophepa visited seven stations during the eight weeks that it was stationed in the Western Cape (between 6 April and 5 June 2009). Data were collected by workers and students on the train. Results: A total of 4 026 prescriptions were dispensed by the pharmacy on Phelophepa during the eight weeks. The average number of items per prescription was 3.51. The average cost per prescription was R65;48 (average cost of R18;64 per item). Patients only paid R5;00 per prescription. There was an increase in the number of pulmonary diseases/infections as well as ophthalmic conditions (especially dry eyes). Common problems experienced during the outreach to schools were ear infections and chest infections. Common conditions identified in Caledon; for example; were musculoskeletal problems; genitourinary conditions; fungal infections and eye disorders. Medication is prescribed mainly by nurses and includes those listed in the Primary Healthcare Essential Drug List. Conclusions: The statistics compiled by Phelophepa are a useful source of pharmacoepidemiological data about rural South Africa. It is recommended that more studies be conducted to detect especially epidemiological differences between regions visited; as well as changes over time

Prevalence of Drug-Drug Interactions of Antiretroviral Agents in the Private Health Care Sector in South Africa

Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART); requiring concomitant administration of three to four different agents; often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book; Drug Interactions Facts and comparisons. Results. A total of 5305882 medicine items were prescribed; of these; 1.92(N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions; 1.68(N=43 482); were ARVs. A total number of 18035 DDIs (81 different types) were identified; of these; 83.89; (n=15130) were DDIs between ARVs and other drugs; while 16.11(n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major; n=17) and 2 (moderate; n=1436) represented 8.06(n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing; there is a great need of understanding and anticipating these DDIs; overcoming them by dose adjustments and patient education by pharmacists; so that they are not life threatening to HIV/AIDS patients

Antimicrobial Prescribing Patterns in a Group of Private Primary Health Care Clinics in South Africa

The aim of this study was to investigate the prescribing of antimicrobials in private primary health care in South Africa. A retrospective drug utilisation study was conducted on data obtained from the database of nine private primary health care clinics for the year 2001. Antimicrobials were classified pharmacologically and their usage analysed according to number of patients and consultations; age groups; gender; diagnoses and cost. Of the 83 655 patients; 49 772 (59.50) were female and 33 650 (40.22) males. No gender was indicated in 233 (0.28) of the cases. Medicine items (n = 515 976) were prescribed costing R1 716 319. Of these; 18.69 (n = 96 421) were antimicrobials costing R1 045 108 (60.89). Antimicrobials were prescribed in 72 of the consultations. The antimicrobials that were the most often prescribed were penicillins (38.17); sulphonamides (22.49); antiprotozoals (9.88) and tetracyclines (9.34) for diagnoses such as viral-influenza; upper-respiratory infections; acute-bronchitis and acute-sinusitis. Antibiotics prescribed for viral diseases indicated inappropriate use because these infections are caused by non-bacterial agents; and thus are self-limiting. Therefore antibiotics were neither necessary nor appropriate. Further investigations should be done on standard antimicrobial treatment-guidelines in private primary health care settings in South Africa

Public Perception of Community Pharmacists in South Africa : Primary Study

This survey forms part of a study undertaken to identify and quantify the community pharmacist's involvement in the use of non-prescription/over-the-counter (OTC) medicine /self-medication in community pharmacies throughout South Africa. The objectives of this study were to establish the public's perception of the role of and the value added by community pharmacists in the treatment of minor ailments. A survey was conducted amongst 300 consumers prior to the recent changes and introduction of new legislation affecting pharmaceutical care and the dispensing of medicine. The major finding of this study was that the majority of consumers who consulted community pharmacists were satisfied with the comprehensiveness of the counselling and the effectiveness of the treatment provided. A large majority of the participants agreed that community pharmacists play a positive role and add value. It was found that the main reason for visiting a specific pharmacy was the proximity of that pharmacy

Knowledge and Perceptions of Pharmacy Students towards Training in Complementary and Alternative Health Care

Complementary and Alternative Health Care (CAHC) is the primary source of health care for over 70 of the world's population. The aim was to determine the knowledge and perceptions of undergraduate pharmacy students towards CAHC; as well as to establish their training needs for CAHC. A questionnaire survey was conducted amongst undergraduate pharmacy students during October 2002 at a South African pharmacy school. A total of 160 questionnaires were analysed. Senior students more accurately defined CAHC than first-and second-year students. Twenty CAHC therapies were listed and participants were asked to firstly indicate their level of knowledge; and secondly; their usage of these therapies. They were most knowledgeable with respect to herbalism (95.0); massage (90.6); traditional African medicine (81.3) and diet therapy (81.3). Massage was the therapy most often used (58.1); followed by herbalism (45.0). Ayurveda; iridology; colonic irrigation and naturopathy were the least often used therapies. Participants indicated that CAHC should be included in the third and fourth year of the B Pharm degree. A need for undergraduate pharmacy students to be trained in the basic principles of CAHC; and for continuing education courses in CAHC; was identified. The current knowledge of pharmacy students regarding CAHC is inadequate

Prescribing Patterns of Methylphenidate in a South African Patient Population who are Members of a Private Medical Aid

Methylphenidate is primarily used for attention deficit hyperactivity disorder (ADHD) in children. The primary aim of the study was to investigate the prescribing patterns of methylphenidate of a medical aid patient population in a private sector and to compare the results with previous studies. An exposure cohort drug utilisation study was conducted. Data were obtained from a South African medical aid administrator. Prescription records for 115 patients who received methylphenidate during 2002 were retrospectively analysed. Nearly three-quarters (73.0) of the patients were males and 79.1of patients were 18 years or younger. The average age of patients was 15.6 (SD=10.8) years. Seventeen patients were 30 years or older. Two-thirds of prescriptions (67.3) were for methylphenidate 10 mg (the innovator product); 20.7were for the 20 mg slow-release innovator product and the rest were prescriptions for the recently introduced 10 mg generic equivalent tablet. Patients received on average 4.0 (SD=3.3) prescriptions for methylphenidate during the year. The average Prescribed Daily Dose (PDD) for methylphenidate was 15.4 (SD=7.6) mg. Further studies are recommended; especially into the quality of life of patients before and after receiving methylphenidate. The impact of methylphenidate on the academic performance of patients should also be quantified

Prescribing of Drugs for the Treatment of Migraine with Specific Emphasis on Sumatriptan

Migraine affects between 5.15of males and 13;5-31of females in South Africa. Little is known about the prescribing patterns of anti-migraine drugs in South Africa. The aim of the study was to investigate the prescribing of drugs for the treatment of migraine (ATC Group NOZC); with specific emphasis on sumatriptan; in a primary care patient population in South Africa; making use of a computerised prescription database. A total of 3 01 1 products for the treatment of migraine at a cost of R451559 were prescribed to 578 patients in the study over a period of one year (1996) since sumatriptan was the onlytriptan available in South Africa in 1996. The average age of patients was 48;40 (SD = 14;19) years; with 74;57ofpatients between 20 and 59 years of age. Approximately 80of patients were females. Female patients were prescribed 81;53of the products. Most drugs (67;55) were for the prophylaxis of migraine; of which clonidine andflunarizine were the most frequentlyprescribed. Of the drugs prescribedspecifically for the management of migraine; sumatriptan (575prescriptions to 103 patients) was the most frequently prescribed; followed by 400 prescriptions for ergotamine. Tablets were the preferred dosage form. Since migraine affects primarily the economically active sector of the community and its treatment is relatively expensive; pharmacists have an important role to play in managing and counselling migraine sufferers