Impact of prescription charges on people living in poverty: A qualitative study.

BACKGROUND: Prescription charges or copayments have been shown to reduce consumption of medicines. For people living in poverty, prescription charges can prevent them from getting the medicines they need, and this can result in poorer health status. Prescription charges are low in New Zealand compared to many other countries, but those living in poverty are not exempt from fees. OBJECTIVES: The aim of this study was to explore the lived experience of people who struggle to pay prescription charges and to propose a model for how being unable to afford prescription charges might affect health. METHODS: Participants were recruited through organizations that provide services entirely or predominantly to low income persons. Semi-structured interviews were carried out with 29 people who had been identified as having problems paying for prescriptions. Approximately half of the sample population was Maori (indigenous New Zealanders). Ethical approval was obtained from the University of Otago. RESULTS: Participants reported having to make difficult decisions when picking up their prescription medicines. These included choosing some medicines and leaving others, such as choosing medicines for mental health rather than physical health; cutting food consumption or eating less healthy food so as to pay for medicines; or picking up medicines for children while leaving those for adults. Participants also reported strategies like reducing doses to make prescriptions last longer; and delaying picking up medicines. These led to sub-optimal dosing or interrupted treatment. CONCLUSIONS: Even low financial barriers can have a significant impact on low income people's access to medicines and reduce the effectiveness of treatment. Not being able to afford prescription medicines may impact negatively on people's health directly by preventing access to medicines, through reducing expenditure on other items need for health, and by potentiating stigma.

Poverty, medicines and health care: It's the little things .

Small patient charges and policies and events that may seem minor to health care professionals can have a big impact on the wellbeing of people living in poverty. Despite good intentions, policies can have unintended consequences for those who are struggling to access health care.

Community pharmacists' perceptions of services that benefit older people in New Zealand.

BACKGROUND: There is limited information in New Zealand about community pharmacists' perceptions of services that benefit older people. OBJECTIVES: To explore the perceptions of community pharmacists' of services that benefit older people; the benefits perceived; and the experiences of pharmacists providing such services. SETTING: Community pharmacies in New Zealand. METHODS: A cross-sectional purpose-developed survey was carried out of all community pharmacies in New Zealand. This was followed by twenty qualitative telephone interviews of pharmacists identified as providing at least one specialized service. Interviews were recorded, transcribed verbatim, and coded for themes using constant comparison. MAIN OUTCOME MEASURES: Community pharmacists' opinions and perceptions in the cross-sectional survey and qualitative interviews. RESULTS: Responses were received from pharmacists in 403/905 evaluable pharmacies. All pharmacies provided some baseline services (advice, dispensing of prescriptions, medicines disposal) and 90% provided home deliveries of medicines. Adherence to medicines was supported by compliance packaging (96%), medication review (Medicines Use Review, MUR) (28%), and repeat prescription reminders (27%). Thirty-five percent provided screening (e.g. cholesterol, blood pressure), and 32% provided medicines education to community groups. Compliance packaging and home delivery were thought the services most beneficial for older people, and should help people adhere to their medicines. The 20 pharmacists interviewed by telephone provided 20 different specialized services (median 2, range 1-4). These included MUR, services to residential homes, visiting educators/special clinics, INR monitoring, services to hospices, and flu vaccination. Benefits perceived included improvements in adherence, patient safety, and patient-knowledge of medicines, and convenient access to services. "Patient need" was a frequent driver of services, and common facilitators for services were having appropriate training/skills, co-operation with health professionals, peer or expert support, sufficient time and funding. A lack of these facilitators were considered barriers as were resistance from general practitioners or the general public, or high set-up costs. CONCLUSION: Community pharmacists in New Zealand perceived they provide a range of services of potential benefit to older people for managing their medicines. Establishing new services requires cooperation from other health professionals, peer support, training, funding and time. Further research into patients' outcomes from new and established services is needed.

Recruitment and retention of primary care patients into a research study investigating medication adherence.

INTRODUCTION: General practitioners (GPs) and patients are key sources of information for investigating primary health care. However, recruiting these into health care studies has been reported to be difficult. AIM: This study aimed to determine the recruitment and retention rates of GP practices and patients into a research project in the primary health care setting. METHODS: All general practices in Dunedin, New Zealand, with three or more practitioners were invited to participate in a study investigating medication adherence. In practices that agreed to participate, 100 patients were recruited from waiting rooms and followed up by telephone over six months. The main outcome measures included recruitment rates of GPs and patients, the level of retention and loss to follow-up of patients over a six-month period, the drop out and reasons for this drop out. RESULTS: Only two of the 15 practices agreed to participate. To recruit 100 patients, 203 people were approached. Reasons for not wanting to participate were recorded where possible. Of those that agreed to participate, 86% of doctor consultations resulted in a prescription and, of these prescriptions, 87% were reported to be collected as prescribed. At the end of six months, 68 patients still remained in the study. DISCUSSION: Patients were interested in being involved in this type of study and were recruited at a rate of 82% and 56% depending on the practice. After the initial drop out, most patients remained in the study until the conclusion. Recruitment of general practices remains challenging.

Ripple-like intraocular lens damage from a neodymium:YAG laser.

We report a case of accidental intraocular lens (IOL) damage during a neodymium:YAG laser capsulotomy. After a single pulse of 0.9 mJ of laser energy, a large area of ripple-like opacity with more than 10 concentric circles surrounding a small hole in a 2.0 diopter IOL was noted. The opacity extended more than one fourth of the IOL diameter and caused a significant visual effect.