Over-the-Counter Medicine Utilization by Beneficiaries Under Medical Schemes in South Africa.

BACKGROUND: South African medical insurance schemes (known as medical schemes) cover about 17% of the population. Within these schemes, access to medicines for a defined set of chronic diseases is mandated by legislation. However, much of the responsibility for treatment of minor conditions with non-prescription over-the-counter (OTC) medicines has been transferred to the individuals within the medical schemes. The overall expenditure on pharmacist-assisted therapy (PAT)/OTC medicines in South Africa is considerable and medical schemes endeavor to limit amounts paid out by devising strategies that will limit their financial exposure. AIM: To investigate how benefit design and other factors within two medical schemes influenced access to and payment for OTC medicines and to explore whether access to OTC medicines by individuals impacted on utilization of other health-care services. METHODS: Medical scheme data were obtained from a leading administrator for two health plans: one with comprehensive benefits covering 4593 beneficiaries (designated HI) and the other with lower benefits covering 54,374 beneficiaries (LO). Extracted data included beneficiary demographics, OTC medicines prescribed by doctors and/or dispensed by pharmacists, and monetary amounts claimed by individuals and paid by the medical schemes. Doctor consultations, costs and payments were also extracted, as were beneficiaries' records of their chronic disease(s) and any episode(s) requiring hospitalization. RESULTS: Some 60-70% of beneficiaries submitted claims for OTC medicines accessed directly or recommended by a pharmacist, and 80-90% claimed OTC medicines that were prescribed by a doctor during a consultation. Amounts claimed and percentages of original products prescribed were substantially higher when accessed directly by beneficiaries or recommended by pharmacists than when doctors prescribed the medicines. In multivariate analysis, there was no clear advantage of offering access to OTC medicines in order to reduce visits to general practitioners, although in the LO plan it appeared that beneficiaries with chronic diseases made less use of the OTC benefit and more use of medical specialists. CONCLUSION: Within these two plans, there were higher costs and greater use of original products when beneficiaries or pharmacies accessed OTC medicines than when these medicines were prescribed by doctors. A key question is whether access to these medicines and the costs thereof would be managed better if paid for directly by individuals and not as insured benefits through the medical scheme.

Cost of ADHD treatment using methylphenidate and atomoxetine in the South African private healthcare sector.

Introduction: The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) has risen over the last two decades, with a corresponding increase in the cost of its medication. Drug utilization studies in South Africa focusing on ADHD are limited.Areas covered: The primary aim was to determine the cost of methylphenidate and atomoxetine (used for ADHD). The Intercontinental Marketing Service (IMS) database which contains data of the private healthcare sector was interrogated from 2013 to 2016 (48-month period) focussing on methylphenidate and atomoxetine. Drug consumption was expressed in number of DDDs, DDDs/1000 inhabitants/day and cost in Rands.Expert opinion: Methylphenidate-containing products constituted a considerably higher percentage of the market share when compared to atomoxetine (90.30% versus 9.70%). The DDD/1000 inhabitants/day for methylphenidate was 6.010 with an annual cost for R266 691 778 in 2013, which increased to 7.827 DDDs/1000 inhabitants/day with an annual cost of R436 041 506 in 2016. Consumption of both methylphenidate and atomoxetine increased from 2013 to 2016. There was a preference for long-acting extended-release methylphenidate tablets even though the unit costs were higher when compared to the short-acting formulations. Despite increases in unit costs, the spend in South Africa showed an upward trend for methylphenidate and atomoxetine.

Review of adult attention-deficit/hyperactivity disorder in South Africa.

INTRODUCTION: Recently, there has been a greater focus on adults with Attention-Deficit/Hyperactivity Disorder (ADHD) given that the symptoms persist in two-thirds of patients into adulthood. Areas covered: A systematic review of articles reporting on adult ADHD in SA was undertaken. From the database search, 1209 articles were identified, with 29 articles included in this analysis. Expert commentary: Fourteen of the 29 studies reviewed were exploratory, 10 were reviews/commentaries, four were developmental studies and one was a phenomenological study. More than half (58.62%) of the articles were published in local South African journals, 13.79% were published in African journals (excluding South Africa), and 27.59% of the articles were published in international journals. The impact factor for nine of the journals were not stated and the remaining 11 have impact factors ranging from 0.207 to 6.78. In 2004, only one article on adult ADHD was published in SA and by 2015, the number of publications increased to six. Adult ADHD is gaining interest in South Africa, however, there have been a limited number of studies conducted thus far. It is recommended that further studies are conducted in this new and developing field.

Identification of potential drug-drug interactions between antiretroviral drugs from prescriptions in the private health-care sector in South Africa.

The aim of this study was to identify potential drug-drug interactions (DDIs) between antiretroviral drugs (ARVs) and to determine whether prescribed daily doses (PDDs) from prescriptions can be used in the evaluation of these interactions. A quantitative, retrospective drug utilization study was performed on 49,995 and 81,096 ARV prescriptions from a South African pharmacy benefit management company, which were prescribed to 7664 and 10,162 HIV patients for 2005 and 2006, respectively. Potential DDIs identified across different age groups were 778 for 2005 and 1155 for 2006; the majority occurred in patients aged 19 to ≤45 years. The potential DDIs identified between ARVs were all interacting at clinical significance level 2 according to guidelines indicated by Tatro. These results demonstrate that potential DDIs were identified between ARVs mostly in three ARV combinations: Kaletra(®) (lopinavir/ritonavir) and efavirenz, lopinavir/ritonavir and nevirapine and combinations of indinavir and ritonavir. There is a need for more education on the prescribing protocols for ARVs in the treatment of HIV-infected patients in the private health-care sector in South Africa.

Prescribing for migraine with the focus on selective 5HT1-receptor agonists: a pharmacy database analysis.

OBJECTIVE: The primary aim was to determine the prescribing patterns and cost of drugs for migraine focusing on selective 5HT1-receptor agonists (triptans) in a primary care patient population. METHODS: A retrospective drug utilization consumption study was conducted. Data were obtained from a South African national private pharmacy group. The database consisted of all central nervous system prescriptions dispensed by the pharmacy group for 2008. RESULTS: A total of 22,102 patients (71.05% females) received 43,144 items for migraine a cost of R3,622,552 (average cost of R83.96 per item). The average age of patients was 44.90 (SD = 13.83) years, with 70.76% of patients between 30 and 59 years of age. A two-sample t-test assuming equal variances was conducted to compare prescribing to females and males. There was a significant difference. There were proportionally more females in the younger age groups and proportionately more males over 60 years. Patients were prescribed an average of 1.95 items for migraine over the year. The Lorenz curve was used to illustrate skewness in prescribing. Clonidine was the most frequently prescribed active ingredient (46.15%), followed by the combination of cyclizine, ergotamine and caffeine (29.62%). The agents for the prophylaxis of migraine (clonidine, flunarizine and pizotifen) accounted for 50.48% of prescribing frequency, but only 29.04% of cost. The triptans accounted for 18.94% of prescribing frequency and 53.54% of cost. Rizatriptan was the most frequently prescribed triptan. CONCLUSIONS: The findings were generally in agreement with other studies, but a lower prescribing rate for triptans was observed.

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 possible drug-drug interactions between antiretroviral agents in different age groups in a section of the private health care sector setting in South Africa.

BACKGROUND: The chronic nature of human immunodeficiency virus (HIV) infection requires lifelong highly active antiretroviral (ARV) therapy (HAART) to continuously suppress HIV-1 viral replication, thus reducing morbidity and mortality. HAART is restricted by complex dosing, drug-drug interactions (DDIs) and toxicities. OBJECTIVE: To determine the prevalence of possible DDIs between ARV drugs in different age groups in a section of the private primary health care sector in South Africa. METHODS: A quantitative, retrospective drug utilization review was performed on 47 085 ARV prescriptions claimed through a national medicine claims database during 2006. Possible DDIs identified were classified according to a clinical significance rating as described by Tatro [Drug Interaction Facts 2005. St Louis, MO: Facts and Comparisons (2005)]. RESULTS: The total number of patients who received prescriptions that were claimed through the medicine claims database was 275 424, of whom 25.11% were males, 28.28% were females and the gender of 46.61% patients was unknown. Of the total number of patients, 3.27% were HIV patients of which an average of 5.23 +/- 3.86 ARV prescriptions (n = 47 085) per patient were claimed for representing 4.73% of the total number of prescriptions claimed during the study period (N = 993 804). HIV patients received an average of 2.36 +/- 0.61 ARVs per prescription. Only 4.95% of the prescriptions had one ARV medicine item, 56.04% two, 37.10% three, 1.75% four and <1% had more than four. Of 960 DDIs identified, 1.88% were for patients < or =6 years, 4.27% for patients >6 years and < or =12 years, 0.63% for patients >12 and < or =19 years, 32.40% for patients <19 years and < or =40 years, 60.21% for patients <40 years and < or =60 years and 0.63% for patients >60 years with patients <40 years and < or =60 years having the highest number of DDIs and patients older than 60 years the lowest. The majority of DDIs between the ARVs presented in significance levels 2 and 4. The most important interactions were between: indinavir (IDV) and ritonavir (n = 199); efavirenz (EFV) and lopinavir/ritonavir (n = 65) and EFV and IDV (n = 60) all interacting at level 2. CONCLUSION: The importance of using drug utilization study as an identification tool to provide insight into the prescribing and utilization patterns of ARV drugs, to provide optimal therapy for patients infected with HIV is emphasized.

Prevalence of drug-drug interactions of antiretroviral agents in the private health care sector in South Africa.

OBJECTIVES: Human immunodeficiency 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 a national medicine claims database for the period 1 January to 31 December 2004. SETTING: A section of the private health care sector in South Africa. SUBJECTS: All ARV prescriptions (N=43 482) claimed during 2004. The possible DDIs found were classified according to a clinical significance rating described by Tatro (2005) in his book Drug Interaction Facts. RESULTS: A total of 5 305 882 medicine items were prescribed; of these, 1.92% (N=101 938) were ARVs. Of the total number of 2 595 254 prescriptions, 1.68% (N=43 482) contained ARVs. A total number of 18 035 DDIs (81 different types) were identified; of these, 83.89% (N=15 130) were DDIs between ARVs and other drugs, while 16.11% (N=2 905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, N=17) and 2 (moderate, N=1 436) 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 need to understand and anticipate these DDIs and to overcome them by dose adjustments and patient education, so that they are not life threatening to HIV/AIDS patients.

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

Methylphenidate: prescribing patterns in a South African primary care patient population.

BACKGROUND AND OBJECTIVE: Sales figures have indicated that there has been a steady increase in the use of methylphenidate in South Africa. The primary aim of the study was to investigate the prescribing of methylphenidate (indicated for Attention Deficit Hyperactivity Disorder in children, and narcolepsy) in a South African primary care patient population. METHODS: A retrospective, exposure cohort drug utilization study was conducted in the South African private health care sector. Data were obtained from a medical aid administrator and were analysed for all patients who received one or more prescriptions for methylphenidate (N06B A04) during 2002. RESULTS AND DISCUSSION: A total of 106 patients received one or more prescriptions for methylphenidate during the year. Ninety of the 106 patients (84.9%) were under 25 years of age (average age 10.51 years, SD=3.92 years). These 90 patients were all single and the majority of them (75.6%) were males. The Lorenz curve was used to illustrate skewness in the prescribing of methylphenidate to the patient population. Patients under the age of 25 years received on average 3.46 prescriptions for methylphenidate during the year. The most common chronic diagnosis category was 'Hyperkinetic Syndrome of Childhood'. Most of the prescriptions were obtained from pharmacies, followed by dispensing doctors and rehabilitation services. CONCLUSION: The results were in agreement with a previous South African study conducted in 1996. Further studies are recommended, especially into the quality of life of patients before and after receiving methylphenidate.

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