Is Reclassification of the Oral Contraceptive Pill from Prescription to Pharmacist-Only Cost Effective? Application of an Economic Evaluation Approach to Regulatory Decisions.

BACKGROUND AND OBJECTIVE: Unplanned pregnancies can lead to poorer maternal and child health outcomes. The Australian Therapeutic Goods Administration committee rejected reclassifying a range of oral contraceptive pills (OCPs) from prescription to pharmacist-only medicines in 2015, mainly based on safety concerns. Improving access to OCPs may encourage some women to use contraceptives or switch from other contraceptive methods. However, some adverse events may increase and some women may stop using condoms, increasing their risk of sexually transmitted infections. This study aimed to estimate the cost effectiveness of reclassifying OCPs from prescription to pharmacist-only. PERSPECTIVE: Healthcare system. SETTING: Australian primary care. METHODS: A Markov model was used to synthesise data from a variety of sources. The model included all Australian women aged 15-49 years (N = 5,644,701). The time horizon was 35 years. Contraceptive use before reclassification was estimated using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, while survey data informed use after reclassification. Health outcomes included pregnancies, pregnancy outcomes (live birth, miscarriage, stillbirth, ectopic pregnancy and abortion), sexually transmitted infections, adverse events (venous thromboembolism, depression, myocardial infarction and stroke), ovarian cancer cases and quality-adjusted life-years. Costs included those related to general practitioner and specialist consultations, contraceptives and other medicines, pharmacist time, hospitalisations and adverse events. All costs were reported in 2016 Australian Dollars. A 5% discount rate was applied to health outcomes and costs. RESULTS: Reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining prescription-only. Thus, reclassifying OCPs was more effective and cost saving. However, a sensitivity analysis found that more research on the probability of pregnancy in women not using contraception and not trying to conceive is needed. CONCLUSION: Reclassifying OCPs is likely to be considered cost effective by Australian decision makers.

Efecto de un sistema automático de dispensación de medicamentos sobre el gasto farmacéutico y el grado de satisfacción del usuario / An automatic dispensing system medications effect in pharmaceutical expenditure and satisfaction user level

Objetivo: Evaluar en términos económicos el efecto de la sustitución de botiquines tradicionales por la implantación de Sistemas Automáticos de Dispensación de Medicamentos en la Unidad de Cuidados Intensivos. Analizar el grado de aceptación de dicho cambio por parte de los usuarios. Método: Para el análisis económico, se consideraron los costes directos e indirectos tangibles, derivados de la implantación: inversión inicial de capital, coste del personal implicado, coste en política de consumo de medicamentos. Todos estos aspectos se evaluaron antes y después de la implantación. El grado de satisfacción de los usuarios se evaluó a través de un cuestionario estandarizado. Resultados: Tras la estimación de los costes, comprobamos que el gasto realizado en la inversión inicial se verá rápidamente compensado fundamentalmente por el coste referido a la política de consumos de medicamentos con una reducción del 24% con respecto al sistema de dispensación anterior. El coste en el capitulo de personal también se ve reducido un 11%, así como el coste/estancia y coste/ingreso que disminuyen un 26% y 30% respectivamente en relación al sistema anterior. La evaluación del cuestionario reveló que los usuarios están satisfechos con la implantación y un 84% del personal de enfermería lo recomendaría a otras unidades. Conclusiones: Los Sistemas Automáticos de Dispensación de Medicamentos constituyen una nueva herramienta tecnológica para el control del gasto farmacéutico, con buena aceptación por parte de los usuarios (AU)

Objective: To evaluate in economic terms, the effect of replacing traditional kits for the implementation of automated dispensing of medications in the Intensive Care Unit. Analyze the degree of acceptance of such changeon the part of users. Method: For the economic analysis is considered tangible direct and indirect costs resulting from the implementation: initial capital investment, cost of staff involved, the political cost of drug consumption. All these aspects were evaluated before and after implantation. The degree of user satisfaction was assessed using a standardized questionnaire. Results: After the estimation of costs, we found that the expenditure incurred on the initial investment will be quickly offset by the cost mainly referred to the politics of consumption of drugs with a reduction of 24% over the previous delivery system. The cost in personal chapter is also reduced by 11%, and the cost per stay and cost / income fell by 26% and 30% respectively over the previous system. The evaluation questionnaire revealed that users are satisfied with the implementation and 84% of nurses would recommend it to other units. Conclusions: Automated Dispensing Systems Drugs are a new technological tool to control drug spending, with good acceptance by users (AU)

Uso de monitorización ambulatoria de la presión arterial en el cribado de la hipertensión arterial: una oportunidad para el farmacéutico comunitario / No disponible

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La administración de especialidades farmacéuticas complejas por vía inhalatoria: actitudes, aptitudes y herramientas / No disponible

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Conocimiento de la técnica de inhalación de medicamentos antiasmáticos por farmacéuticos comunitarios / No disponible

Introducción: Una técnica de inhalación incorrecta contribuye de forma importante a la falta de efectividad de los medicamentos antiasmáticos y provoca frecuentes efectos adversos a nivel orofaringeo. Estudios anteriores han evidenciado altos niveles de desconocimiento de la técnica inhalatoria adecuada por parte de pacientes y profesionales sanitarios. Objetivo: Analizar el conocimiento de la técnica de inhalación por parte de farmacéuticos comunitarios. Material y métodos: Se analizó mediante 3 cuestionarios (checklist) para 3 dispositivos (Aerosol Presurizado, Turbuhaler y Accuhaler) el conocimiento de los diferentes pasos necesarios para inhalar correctamente, en una muestra de 28 farmacéuticos comunitarios. Resultados: El porcentaje medio de pasos correctos fue de 55,9% en Turbuhaler, 49,4% en Accuhaler y 47,4% en Aerosol Presurizado (AU)

Background: A correct inhalation technique contributes significantly to the lack of effectiveness of asthma medications, and causes frequent adverse effects at the pharynx level. Previous studies have showed poor knowledge of the correct inhalation technique by both patients and health professionals. Objective: To analyse the knowledge of the inhalation technique by community pharmacists. Methods: 3 checklists for 3 devices (Metered-Dose inhaler, Turbuhaler and Accuhaler) were used to analyse the knowledge of the different steps needed to inhale correct/y, in a sample of 28 community pharmacists. Results: The mean percentage of correct steps was 55.9% with Turbuhaler, 49,4% with Accuhaler, and 47,4% with Metered-Dose Inhaler. Conclusions: There is an alarming lack of knowledge (55,9% with Turbuhaler, 49,4% with Accuhaler, and 47,4% with Metered-Dose Inhaler) about the correct sequence of steps for the administration of inhaled asthma medications, by the community pharmacist included in the sample (AU)

Problemas relacionados con medicamentos identificados en pacientes asmáticos / No disponible

Introducción: A pesar de las mejoras terapéuticas conseguidas en los últimos años, existe un bajo nivel de seguimiento de las recomendaciones internacionales sobre manejo del asma, así como un insuficiente control del asma en general. Se han descrito problemas de educación de los pacientes, falta de adherencia y técnica de inhalación incorrecta. Objetivo: Describirlos PRM que se presentan con mayor frecuencia en pacientes asmáticos atendidos en un programa de seguimiento farmacoterapéutico en farmacia comunitaria, y medir el grado de resolución de dichos PRM. Material y métodos: Se analizan los PRM identificados en 96 pacientes captados en 20 farmacias. Se utilizaron entrevistas de inicio/cierre, y registros de visita, en los que se tuvieron en cuenta las siguientes variables: sexo, edad, causa, categoría, PRM, consecuencia, medicación responsable, intervención farmacéutica y resolución. Resultados: Se identificaron 116 PRM en 65 pacientes. La mayoría pertenecían a la categoría de efectividad (60,3%), seguida de seguridad (21,6%), e indicación (18,1%). La intervención farmacéutica se realizó fundamentalmente con el paciente (30,2 % explicación sobre utilización, y 24,1% ayuda al cumplimiento), y en un 45,7% se produjo derivación al médico. Se resolvió el PRM en un 75,9% de las ocasiones. Conclusiones: Los PRM más frecuentes en asmáticos pertenecen a la categoría de efectividad (60,3%). La intervención farmacéutica consigue resolver los PRM identificados en una elevada proporción (75,9%) (AU)

Background: Despite the therapeutic improvements achieved in last years, there is a low level of use of the international asthma management guides, and a wide poorly asthma control. Problems with patient education, lack of adherence and bad inhalation technique have been described. Objective: To describe the most common drug related problems in patients with asthma following a pharmaceutical care program in community pharmacy, and to measure the solution of such problems. Methods: Drug related problems identified in 96 patients from 20 pharmacies were analysed. Initial/Final interviews, and visit registers were used, including the next variables: sex, age, cause, category, drug related problem, consequence, medication, pharmaceutical intervention, and solution. ResuIts: 116 drug related problems were identified in 65 patients, in most cases included in the effectiveness category (60,3%), followed by safety (21,6%), and indication (18,1%). Pharmaceutical interventions were developed with the patient for the most part (30,2% explanation about use, 24,1% compliance aid), and derivation to doctor was needed in 45,7% of cases. 75,9% of drug related problems were solved. Conclusions: The most common drug related problems in patients with asthma belong to the effectiveness category (60,3%). Pharmaceutical interventions salve drug related problems in a high proportion of cases (75,9%) (AU)