INRUDInternational Network for the Rational Use of Drugs

INRUDInternational Network for the Rational Use of DrugsNews

Newsletter of the International Network for the Rational Use of Drugs

Volume 21, Number 1 January 2011

The World Medicines Situation Report 2010

RIchaRD LaINg, EDELIsa caRaNDaNg, aND KathLEEN hURst

In 1988 and again in 2004, the World Health Organization (WHO) published reports on the World Medicines Situation. The first edition was brief and described the beginning of the essential medicines movement. In 2004, a more comprehensive report was issued that contained nine chapters that reviewed all aspects of medicines in both developed and developing countries.

In 2009, WHO decided to produce a new World Medicines Situation Report in 2010. As times have changed, the report will be released electronically in a series of individual chapters, with the first five chapters being released in December 2010. This time, there will be 24 chapters, each written by different authors and covering topics related

to production and consumption, innovation, regulation, and safety. The report will include chapters about medicines selection, procurement, supply management, rational use, financing, and pricing. There are also cross-cutting chapters related to household medicines use, access and human rights, good governance, human resources, and national medicines policies.

Identifying lead authors (who frequently created teams to work with them) was the first step in producing these chapters. The first draft was extensively reviewed by members of various WHO expert panels, WHO country staff, academics, and nongovernmental organization staff who work on essential medicines issues. IMS Health staff produced two chapters and provided data for others.

The first five chapters to be released on the WHO Medicines web site in December 2010 will be—

• Rational Use of Medicines• Good Governance for the

Pharmaceutical Sector• Prices, Availability, and Affordability• Access to Controlled Medicines• Traditional Medicine: Global

Situation, Issues, and Challenges

This process produced some interesting findings. For example, according to the National Health Accounts for 2005 and 2006, 18 percent of the world’s

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population living in high-income countries consumed 80.3 percent of the world’s medicines by value and the 10.6 percent of the world’s population living in low-income countries consumed 0.5 percent of the world’s medicines by value.

In terms of volumes, the situation was less extreme. In the 67 countries where IMS Health collected data, they estimated that 55 percent of the volume of medicines was consumed in high-income countries whereas 8 percent of the volume was consumed in low-income countries.

When looking at the use of medicines, the new edition reveals that, although many of the INRUD indicators have not changed much since the last report, adherence to treatment guidelines has

increased to close to 50 percent and the rate of injection use has fallen. The report includes short case studies that identify examples of successful projects or national programs. Authors do not provide recommendations for what countries should do, but provide substantial information on the

national choices that can be made. The main target audience for the new edition is senior health policy-makers, primarily those in developing and transitional countries.

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Boston Core GroupDR. DENNIs Ross-DEgNaN

The INRUD/Boston group consists of faculty and staff members from the World Health Organization (WHO) Collaborating Center in Pharmaceutical Policy. The center is involved in a wide range of teaching and research activities related to access to and use of medicines. Its biweekly pharmaceutical policy research seminar in the Department of Population Medicine focuses on methods for pharmaceutical policy research and international and domestic medicine policy issues. Presentation slides and background readings are posted online and live participation included staff members from the National Public Health Institute in Mexico and faculty members from the University of Nottingham in the UK via video conference.

The INRUD/Boston group continues to be actively involved in the development of the Third ICIUM Conference, which will be held in Alexandria, Egypt, April 10–14, 2011. The Scientific Program Committee is chaired by Dr. Anita Wagner, with Dr. Catherine Vialle-Valentin coordinating the work of the groups developing the eight conference tracks.

Members of the INRUD/Boston group from the Center for Global Health and Development and Department of International Health, located at Boston University, continue their work in medicines policy and practice. Policies for treating particular illnesses with appropriate drugs do not immediately translate into improved access to those drugs for affected populations. There may be a disincentive to create new medicines for certain diseases because a ‘market’ is lacking. Trade and intellectual property barriers may impede access. Distribution channels may lag behind policy protocol so that medications are understocked at pharmacies—particularly in remote regions—or are too expensive for the people for whom they are intended. Corruption in the pharmaceutical sector

and counterfeit medicines may hamper efforts to provide quality-assured medicines. In addition, people may be reluctant to take various drugs for many reasons, including economic constraints, cultural taboos, and lack of information. Finally, sometimes available drugs are taken when they shouldn’t be because of a lack of understanding about the conditions for which they are appropriate. Boston University’s research aims to improve understanding of these gaps between policy and practice and recommend actions to address them.

The pilot phase of the Medicines Transparency Alliance (MeTA) is now completed. Both MeTA tools developed by members of the INRUD/Boston group and the pharmaceutical sector baseline assessments of several pilot countries are now available on line. The INRUD/Boston group continues to support WHO in its efforts to improve existing tools that monitor country pharmaceutical situations and produce meaningful country profiles.

The Harvard Fellowship in Pharmaceutical Policy Research is pleased to begin a program supported by the China Medical Board targeted at junior faculty from Chinese universities who are interested in six months of specialized training in pharmaceutical policy research. This is a very timely program, given the importance of pharmaceutical policy issues in the recent China health reform. The first two fellows are Yang Li and Bin Jiang, both from Peking University.

Recent publications by members of the INRUD/Boston group include—

Miller, C. M., Ketlhapile, M., Rybasack-Smith, H., Rosen, S. Why are Antiretroviral Treatment Patients Lost to Follow-Up? A Qualitative Study from South Africa Trop. Med. Int. Health. 2010 Jul; 15 Suppl 1:48-54.

Sabin, L. L., DeSilva, M. B., Hamer, D. H., Xu, K., Zhang, J., Li, T., Wilson, I. B., Gill, C. J. Using

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Electronic Drug Monitor Feedback to Improve Adherence to Antiretroviral Therapy among HIV-Positive Patients in China. AIDS Behav. 2009 Sep; 14(3):580-9.

Wagner, A. K., Graves, A. J., Reiss, S., LeCates, R., Zhang, F., Ross-Degnan, D. Access to Care and Medicines, Burden of Health Care Expenditures, and Risk Protection: Results from the World Health Survey. Health Policy 2010. DOI: 10.1016/j.healthpol.2010.08.004.

Yeboah-Antwi, K., Pilingana, P., Macleod, W. B., Semrau, K., Siazeele, K., Kalesha, P., Hamainza, B., Seidenberg, P., Mazimba, A., Sabin, L., Kamholz, K., Thea, D. M., Hamer, D. H. Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial. PLoS Med. 2010 Sep; 7(9).

Faden, L., Vialle-Valentin, C., Ross-Degnan, D., Wagner, A. K. Active Pharmaceutical Management Strategies of Health Insurance Systems to Improve Cost-Effective Use of Medicines in Low- and Middle-Income Countries: A Systematic Review of Current Evidence. Health Policy (in press).

Carapinha, J., Ross-Degnan, D., Desta, A., Wagner, A. K. Health insurance systems in five Sub-Saharan African countries: Medicines benefits and data for decision making. Health Policy (in press).

Ethiopia Core GrouptENaw aNDUaLEm

Patient Education and Empowerment: Antiretroviral Treatment Adherence Aids in Ethiopia

Medicines safety and adherence are the challenges in chronic care disease management and were also supported during the antiretroviral therapy (ART) determinants assessment in Ethiopia. As one of the interventions to assist patients to cope with these difficulties, we developed patient education and empowerment booklets in Amharic on nine different fixed-dose-combination first line and alternative ART regimens.

These materials stress the importance of adherence, how to recognize side effects and differentiate from co-morbidity, and how to manage the side effects of the medicines. At the end of every side effects management, there is also space to record their encounters, actions taken, and improvements as a result of the actions. The fixed dose combination regimes for which ART adherence aids were developed are TDF 3TC EFV, TDF 3TC NVP, TDF FTC EFV, ABC 3TC NVP, ABC 3TC EFV, d4T 3TC EFV, d4T 3TC NVP, AZT 3TC EFV, and AZT 3TC NVP.

samples of the cover pages for aZt 3tc NVp and tDF 3tc EFV regimens

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These education aids target not only patients, but also peer counselors and health care providers who can use them for individual counseling and group education sessions. These adherence aids, along with other interventions that target improving medicines dispensing practices and counseling services, form synergy to promote the rational use of medicines.

Live Rational Medicines Use Intervention in Ethiopia

A one-hour live rational medicines use intervention was transmitted through Ethiopian television on October 30, 2010. The program was interactive and was repeated on November 4 and 5, 2010. Tenaw Andualem from SPS and Mengstab W. Aregay from the Food, Medicines, and Health Care Administration and Control Authority were interviewed by a journalist and answered insightful questions from the audience. E-mail and telephone feedback indicated that the broadcast was well received. This broadcast was the latest in a series of radio and print transmissions on the different aspects of rational medicines use, such as self-medication, adherence to treatment, and antimicrobial resistance.

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India—Delhi Core GroupDR. Usha gUpta

INRUD/Delhi was involved in the following activities between May and October 2010.

Activities

• Two training programs for pharmacists working at antiretroviral therapy centers in India were conducted in Delhi on June 11 and 12 and September 7 and 8. The primary objective of the training program was to test the training manual developed by the group and the National AIDS Control Organization of India (NACO). The pharmacists were trained in the procurement and rational use of antiretroviral medicines, drug store management, patient education, adverse drug reactions, and drug–drug interactions. Because the objective of the program was to test the manual, the participants were evaluated on their knowledge before and after the training; it was concluded that the manual met the educational requirements of the pharmacists.

mr. R. parameswar leads a session at the antiretroviral therapy training program for

pharmacists sponsored by the National aIDs control program, phase III. pharmacists and

faculty from Naco also participated.

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• To measure health-seeking behavior and medical treatment in the community, a survey was conducted in different colonies of Delhi that included households of varying socio-economic status. The survey by trained field investigators has since been completed and the data are being analyzed.

• Mr. R. Parameswar, Dr. Usha Gupta, and Dr. Sangeeta Sharma participated in the intercountry meeting on promoting rational use of medicines organized by the World Health Organization (WHO)/South-East Asia Regional Office on June 13–15. This was a follow up to the meeting organized by WHO in December 2007 in Bangkok on the role of education in the rational use of medicines.

• The Government of India has taken a step to formulate a National Antimicrobial Policy. A task force was created and Professor Ranjit Roy Chaudhury and Professor Usha Gupta were nominated as members. They participated in a series of meetings to finalize the policy; the last meeting of the task force was held on October 20 at the India Habitat Centre, New Delhi.

India—Tamil Nadu Core GroupDR. R. mURaLI

Seminar on the Rational Use of Antiretroviral Therapy

SRM Medical College Hospital & Research Centre organized a seminar on the Rational Use of Antiretroviral Drugs for the resident medical officers on October 12, 2010. Dr. S. Gopalakrishnan, Professor Dr. K. R. John, and Dr. M. Logaraj acted as resource persons.

The participants had a detailed discussion about the various issues related to the initiation and follow up of antiretroviral therapy and on various factors which may hamper the continuation of therapy. The session turned out to be highly interactive with all the interns and faculty actively participating and giving their inputs based on their experiences.

Seminar on Drug Interactions in the Treatment of Pulmonary Hypertension

In the January 10, 2010, seminar Management of Pulmonary Hypertension, organized by the Department of Medicine, Chettinad Hospital and Research Institute, cardiologist Dr. Chokkalingam discussed the issues relating to drug interactions and management of pulmonary hypertension at the Chettinad health facility.

The discussion ranged from factors affecting clearance of medicines to the highest recommended doses that can be prescribed instead of the lowest necessary dose to maintain control. The whole session was highly informative and contributed to the overall knowledge regarding the treatment protocol of pulmonary hypertension. It was enthusiastically attended by all the interns and junior doctors, including some of the final year M.B.B.S students who didn’t hesitate to submit queries which Dr. Chokkalingam answered.

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Health Awareness Program on Drug Compliance

Dr. I. Selvaraj conducted a health awareness program for the railway community in Chennai division on drug compliance and adequate monitoring of chronic illnesses like diabetes, hypertension, and ischemic heart disease. The program has been conducted at frequent intervals in various health units in Chennai from April 2009 to September 2010. Glucose levels, lipid levels, and other basic tests were carried out; health education, adherence to treatment, regular follow up, and dietary patterns were emphasized.

Screening programs for diabetes, hypertension, carcinoma of the breast and cervix, and diesel contact dermatitis were also conducted at all Chennai health units during that time period. In an advocacy program on medicines used for treatment, medicines’ side effects were discussed with the participants.

Training on the Rational Use of Drugs in Psychiatric Disorders

A training program was organized for the health care sector on rational use of drugs in psychiatric disorders on September 14, 2010, at Shollin-ganallur, Karpakkam Centre, Kanjipuram District. The program was primarily intended to be a discussion forum on how to combat irrational drug use; psychiatric problems are often misdiagnosed and wrongly treated or not diagnosed at all. Dr. Ravivarman, Professor of Community Medicine, conducted the program and stressed the need for vigilance in the treatment and follow up of patients for early identification of drug interactions.

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Dr. Ravivarman discusses the rational use of drugs with participants

Training Programs for Health Workers in the Medical Department at Chennai Division Railways

In July 2009, a program was held for about 70 pharmacists on material management, inventory control of medicines, procurement policy, and quantitative and qualitative drug analysis. Dr. I. Selvaraj acted as resource person for the training program.

In September 2009, a program was held for about 50 health inspectors to update them on integrated vector control and the rational use of antimalarial drugs.

On September 29, 2009, a program for medical officers was held on auditing medical prescriptions. Dr. Sivakami, Dr. Muralither, and Dr. I. Selvaraj acted as resource persons.

Mobile Medical Unit to Promote Rational Drug Use

SRM Medical College Hospital & Research Centre under SRM University has started a mobile medical advocacy unit for the Kattankulathur Block in the Kancheepuram District of Tamil Nadu. The population of Kattankulathur Block is 274,574. The mobile health clinic will screen for

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common illnesses and provide health education to community leaders, self-help groups, and school teachers and children on the ill effects caused by irrational use of drugs.

Epidemiological Study on Mental Health Morbidity in the Rural Population

An epidemiological study on mental health mor-bidity and the use of medicines to combat it was conducted on those members of the population who registered at the Rural Health Training Center in Poonjeri. It is considered a baseline study for further evaluation and assessment of the prevalence of various mental health disorders and the common medicines used for treatment.

On this occasion, Dr. Nambi, Professor of Psychiatry, and Dr. Ravivarman appropriately organized a program on alcoholism, dementia, and the rational use of drugs for panchayat members, self-help groups, the youth wing of the village, and informal leaders at Poonjeri rural health centers on September 25, 2010. The aim of the program was to sensitize nongovernmental organizations to the problem of taking medicines without prescriptions.

participants attending the community health program

Upcoming Events

• Public and private medical colleges to organize training programs on prescription audits, a registry for drug interactions, and advocacy programs for the public on rational use of drugs

• Introduction of a credit-based continuing medical education program in Tamil Nadu

• Dr. M.G.R. Medical University, in collaboration with Indian Medical Association Branch in Tamil Nadu, to offer a course on the rational use of drugs for medical officers in primary health centers

• Extend an invitation to the new working group to share information on rational use of drugs to medical officers in southern India through the Indian Association of Occupational Health and Indian Medical Association

• Form a consultancy group to advise on research activities on the rational use of drugs in southern states in India

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Kyrgyzstan Core Group ReportsaLtaNat moLDoIsaEVa

Almost all members of the INRUD/Kyrgyzstan Core Group are faculty at the Basic and Clinical Pharmacology Department (BCPD) of the Kyrgyz State Medical Academy and provide guidance on rational use of drugs. In September 2010, the BCPD and the United Nations Educational, Scientific, and Cultural Organization (UNESCO) set up activities for testing UNESCO’s Bioethics Core Curriculum in our academic and post diploma level programs. BCPD and UNESCO planned to sign a memorandum of understanding in November 2010. It would be the first test of UNESCO’s Bioethics Core Curriculum in central Asia.

Two of our members, Professor Tilekeeva Ulangul, head of the BCPD of the Kyrgyz State Medical Academy, and Professor Zurdinova Aida, head of BCPD at the Kyrgyz Russian Slavic University, participated in the 2nd International Conference QIQUM or Quality Information for Quality Use of Medicines (http://www.evidenceupdate-tatarstan.ru/conferen/). The conference was held in Kazan, Russian Federation. More than 300 specialists from 9 countries took active part in this event. Five years have passed since the first QIQUM conference.

According to the organizing committee’s wel- come message, pharmacological, pharmaceutical, and epidemiological studies aimed at improving pharmacotherapy and individualized drug treat- ment and personalized medicine have markedly advanced during this period. Delivering independent comparative information on the effects of pharmaceutical interventions has become more important. Analysis of the results of randomized, controlled trials; pharmacoepidemiology studies; and the practicality of these achievements are being broadly and critically discussed.

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An arsenal of new knowledge on misleading pharmaceutical information and its deleterious effects on prescribing practices has been accumulated. The concept of evidence-based medicine—clinical epidemiology—has influenced and changed the science and practice of modern health. The search for and development of new approaches and new information technologies to enable the improvement of selection for essential medicines lists and standard treatments guidelines is on-going.

New technologies for managing pharmaceutical knowledge for health practitioners and delivering health and medicine information to the public are urgently needed. Information, from basic drug research to drug effects, safety, and public health value must find its way to those who need it. All of these issues of new medicine knowledge management for the health and welfare of the people were discussed at the 2nd International Conference QIQUM.

professor tilekeeva Ulangul (right) talks with a colleague at the QIQUm conference in october

2010.

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health security as well as a recommendation from the ICIUM conference in 2004 that advocated the use of children as change agents in improving community medicine.

Some of the AMR challenges faced in the CoRSUM network countries include the lack of both infection control committees and a national strategy on containment of AMR; counterfeit medicines; the widespread availability and inappropriate use of antibiotics by patients and health care providers; and the widespread use of antibiotics in veterinary health and agriculture. In addition, in many countries, little information exists about the nature of the AMR problem in their specific context; when information is available, it is not widely shared and discussed among stakeholders. The main interventions by CoRSUM have included school-based projects to decrease inappropriate antibiotic use and Drugs and Therapeutics Committee (DTC) training in Moldova and other newly independent states for establishing DTCs at health facilities. CoRSUM is also responsible for translating AMR advocacy material into Russian.

Lessons learned from the work in Zambia, Ethiopia, and other countries of Africa—

• Frame AMR advocacy and containment as “value added” in the context of existing program priorities rather than presenting it as a separate, vertical, and competing activity

• Focus initial information gathering on identifying key issues and stakeholders to provide the basis for quickly starting the national-level process for AMR containment

• Identify and work with a suitable local champion group that can lead the in-country process and ensure that the champion group—o Includes respected opinion leaders to

legitimize activities and change agents to carry them out

o Clearly articulates its objectives from the outset

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Moldova Core GroupDR. NataLIa cEbotaRENco

Beyond Awareness: Consolidating Actions for AMR Containment The antimicrobial resistance (AMR) workshop, Beyond Awareness: Consolidating Actions for AMR Containment, was a session for sharing progress on AMR activities and interventions from prior workshops and to make further plans for addressing advocacy and containment issues. The workshop was attended by 19 participants from 15 countries and took place in Nairobi, Kenya, at the Heron Hotel, May 5–7, 2010. The facilitators were Donna Kusemererwa and Anke Meiburg from the Ecumenical Pharmaceutical Network (EPN) and Terry Green from Strengthening Pharmaceutical Systems (SPS). The workshop included presentations on AMR, tools, workplan progress reports, development of new workplans, and revision of EPN tools.

Workshop objectives

• Share experiences and accomplishments since the November 2008 Moshi workshop, evaluate progress made, and discuss how to strengthen interventions

• Review the approaches and tools established by EPN and SPS and other EPN partners

• Develop approaches and interventions to galvanize greater action for AMR containment within the church health system

• Develop plans for the secretariat and members to continue advocacy and containment

Natalia Cebotarenco gave a presentation about the work of the Coalition for Rational and Safe Use of Medicines (CoRSUM) in the field of AMR and the rational use of antibiotics. AMR activities in CoRSUM are based on World Health Assembly resolution 58.27 that calls for the containment of AMR and the promotion of rational use of antimicrobial agents as a means to improve global

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o Plays the role of a catalyzing body rather than being the “one and only” action body

• Use advocacy as a central strategy, but ensure that it supports the objectives rather than being an end in itself

• Emphasize the continuous nature of the national AMR containment process

Given the complexity of the AMR problem and the many interventions that can be implemented, it is very difficult to determine the best interventions to use at the country, regional, and local levels. As many stakeholders as possible need to be involved—one organization or group cannot take on this enormous problem alone. Efforts must be synergized to maximize the effectiveness of all available resources. Key points for AMR advocacy and containment programs and interventions include—

• Developing a coalition of experts at the local and regional levels to catalyze the process to develop successful AMR interventions

• Mobilizing local stakeholders around the common issue of drug resistance for coordinated and collaborative action and success of the initiative

• Emphasizing that much is already known about the causes of AMR and what can be done to contain and prevent it and that there is no need to wait for more information to act immediately

• Focusing on realistic local strategies that capitalize on existing initiatives and catalyzing new ones

• Emphasizing that the containment and prevention of AMR adds value to existing health programs, such as malaria, HIV/AIDS, and tuberculosis, and is not a competing vertical program

Participants were equipped with tools for AMR containment such as Building Local Coalitions for Containing Drug Resistance: A Guide (February 2008) published by Management

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Sciences for Health with support from the US Agency for International Development. This guide can help AMR stakeholders organize a collaborative effort to locally address drug resistance. The priority interventions outlined in the World Health Organization’s Global Strategy are coupled with advocacy efforts to achieve the critical mass of activity needed for a coordinated, multidisciplinary, coalition-based approach to containing drug resistance.

participants of the international workshop beyond awareness: consolidating actions for

amR containment, Nairobi, africa, may 5-7, 2010.

Capacity Building Initiative on Antibiotic Use in Moldova INRUD/Moldova/CoRSUM continues their work in the containment of AMR; 2010 activities were supported by EPN and React.

INRUD/Moldova is a core group of CoRSUM that links a wide range of health care providers, medicine policy makers, public interest nongovernmental and faith-based organizations, consumers, and networks mainly in Armenia, Uzbekistan, Moldova, Kazakhstan, Tajikistan, Ukraine, and Russia to improve the quality of health, increase access, and improve the rational and safe use of essential medicines.

Building on early work since 1995 as individual organizations led to the establishment in 2005

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of the CoRSUM network in recognition of the key role that collaboration plays when based on mutual interests and common positions to improve public health.

.

the brochure call for action (by the Ecumenical pharmaceutical Network) is available in English,

Russian, French, and spanish.

Conducted a media campaign

• Translated Call to Action: Fight AMR! Save medicines for our children and Infection Control Advocacy Tool into Russian and English and disseminated it to physicians, pharmacists, medical students, journalists, and consumers in Moldova and newly independent states

• Wrote and distributed the pamphlet Antibiotic Resistance is Threatening our Future

• Shared AMR information via a mailing database

Conducted a capacity-building workshop

The main objectives of the workshop were to empower the DTCs in Moldova to play a role in the rational use of antibiotics and in containing AMR at the district level and to upgrade the knowledge and skills of health care workers.

The workshop was successfully conducted on September, 17, 2010, in Telenesti District

Hospital; 22 family doctors, pharmacists, and district hospital specialists participated. The four principal facilitators were Dr. N. Cebotarenco, PhD; Dr. I. Jacobet, MD; Dr. V. Guzun, chief of the Telenesti District Hospital; and Dr. M. Cetulean, chief of the Tuberculosis Municipal Hospital from Chisinau, the capital of Moldova.

The participants decided that the following issues must be addressed to contain AMR—

• The low level of awareness about AMR and infection control among health care workers and patients

• Poor infection control practices in health facilities

• Inappropriate use of antimicrobials in health facilities

• Insufficient coverage about AMR in the national and regional scientific press

They concluded that DTCs should play a key role in containing AMR.

Conducted an AMR kickoff meeting for stakeholders

The meeting took place in Chisinau at the Alumni Centre of the US Embassy on October, 14, 2010. The meeting was linked via video conference to Dr. Elena Stepkina at the Public Health School of Kazakhstan and to Dr. Anahit Ayvazian and Dr. Lilit Ghazaryan of the Department of Rational Use of Drugs, Monitoring of Adverse Drug Reactions and Professional Information Scientific Centre of Drug and Medical Technology of the Republic of Armenia. We were very lucky to have two keynote speakers from the Ukraine, Dr. Andrey Boyko and Dr. Ekaterina Pushak, Assistant Professors from the Pharmaceutical Department of the Medical and Pharmacy University in Lviv.

A major part of the meeting included presentations from those with experiences at the global and regional levels—Bender, Telenesti, Tiraspol, Bassarabeasca, Strefan Voda, Causeni District

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Hospital, and the Tuberculosis Municipal Hospital. The presenters shared information about antibiotic use at the hospital and ambulatory levels, including problems such as overuse of antibiotics, lack of antibiotics’ sensitivity tests, insufficient capacity of microbiology labs, and the lack of collaboration between the Ministry of Agriculture and the Ministry of Health. The meeting concentrated on how to involve different stakeholders, such as representatives of the Ministry of Agriculture, the Ministry of Education, and the mass media, in the discussion on the design of the national plan on AMR.

participants of the contain antimicrobial Resistance

meeting from moldova, Ukraine, armenia, and tiraspol held october 14, 2010, at the alumni

centre at the Us Embassy, chisinau, moldova.

Participants underscored that the instability of the political situation in Moldova threatens to disrupt the efforts to establish the national committee on the containment of AMR. Therefore, the activity should be continued with hospitals, DTCs, and Centers for Disease Control and Prevention at the regional level.

Supported European Antibiotic Awareness Day, November 18, 2010

Recognizing the importance of infection control and the contributions to AMR in hospitals, CoRSUM carried out a campaign to increase awareness about proper infection control and antibiotic use within hospitals in Moldova and other newly independent states as part of the European Antibiotic Awareness Day activities.

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Text from the Pamphlet Entitled Antibiotic Resistance is Threatening Our Future

In the 1940s, the widespread availability of penicillin and the subsequent discovery of streptomycin led to a dramatic reduction in illness and death from infectious diseases. However, germs have a remarkable ability to mutate and acquire resistance genes from other organisms and thereby develop resistance to antimicrobial drugs.

When an antimicrobial drug is used, the selective pressure exerted by the drug favors the growth of organisms that are resistant to the drug’s action. Drug-resistant pathogens are a growing menace to all people, regardless of age, gender, or socioeconomic background. They endanger people in affluent, industrial societies, as well as in less developed nations such as Moldova. In developing countries, relatively high levels of availability and consumption have led to disproportionately higher incidence of inappropriate use and greater levels of resistance compared to developed countries (Global Tuberculosis Control 2009: Epidemiology, Strategy, Financing [WHO Report 2009 WHO/HTM/TB/2009.411]).

Antibiotic resistance creates a threat to global health, because humanity loses effective anti-biotics. Today’s reality is that the introduction of new antibiotics is lagging behind the emergence of resistance, increasing the risk of serious health implications. In some cases there are practically no alternatives when it comes to treatment of severe infections caused by certain strains of multi-drug resistant bacteria.

Antimicrobial resistance is rapidly reducing the effectiveness of these life-saving medicines. This impacts all infectious diseases including HIV, TB, malaria and pneumonia. According to new data from the Fourth Global Report Anti-Tuberculosis Drug Resistance in the World (WHO/HTM/TB/2008.394, Geneva, 2008), among new cases of tuberculosis, the prevalence of resistance to

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coherent policy framework that will address the recent challenges to health and health equity and develop cost-effective policies and strategies to respond to them in an effective way.

Some of the most pressing priorities addressed at this meeting—

• The European region has been polio-free since 2002, but in April 2010, 171 cases of acute flaccid paralysis were reported by the Ministry of Health of the Republic of Tajikistan; 32 of these cases were confirmed as wild poliovirus type 1 and results are pending for the rest. There have been 12 deaths.

• Multidrug-resistant and extensively drug-resistant tuberculosis (M/XDR-TB) is a global health threat in Europe. Out of the 27 high-burden MDR-TB countries that collectively account for 85 percent of the cases globally, the first 15 are in the European region. WHO Euro is in the process of preparing a comprehensive action plan to fight M/XDR-TB in 2010–2015.

• Antimicrobial resistance (AMR) is another global threat and will be the topic of the next World Health Day in 2011. The European

region has started to prepare a regional AMR strategy. A coordinated and strong international response in surveillance and research, the prudent use of antibiotics, and effective programs against health-care-associated infections are needed.

• HIV/AIDS remains another major public health challenge, with rapidly increasing transmission in many European countries. Eastern Europe now has the fastest-growing HIV epidemic in the world and is the only region where the annual number of reported cases of HIV is still increasing.

any anti-TB drug is higher than 40 percent in Moldova. Multidrug-resistant TB prevalence is 19.4 percent. Furthermore, it is known that the incentives are weak to develop new antibiotics to address the global problem of drug resistance. Despite the urgent need for new anti-TB drugs, according to the Stop TB Partnership’s Global Plan to Stop TB 2006–2015, the first new anti-TB drug is not expected until 2015.

The problem of antibiotic resistance is threatening our future. The current generation has the ethical obligation to reverse this process. Concrete actions on combating AMR require the commitment of governments and politicians to changes in social and individual behaviors.

Participation in the 60th Session of the WHO Regional Committee for EuropeThe 60th session of WHO’s Regional Committee for Europe was held in Moscow, Russian Federation, September 13–16, 2010, with representatives from 52 countries participating. Also present were representatives of the Joint United Nations (UN) Programme on HIV/AIDS, the UN Children’s Fund, the UN Development Programme, the UN Economic Commission for Europe, the UN Environment Programme, the UN Population Fund, the World Bank, the Council of Europe, the European Union, the Organisation for Economic Co-operation and Development, and other nongovernmental organizations.

Health 2020, a new European health policy, will be developed through a participatory process involving member states and other partners. The objective is to ensure an evidence-based and

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It is not difficult to make microbes resistant to penicillin...The time may come when penicillin can

be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal

quantities of the drug make them resistant.”

Alexander Fleming’s Nobel Prize Acceptance Lecture, 1945

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At the round table, Dr. N. Cebotarenco, on behalf of the World Council of Churches, made the presentation “The Role of NGOs, Faith-Based, and Other Civil Society Organizations in Support of the Global Strategy for Women’s and Children’s Health.” The Global Strategy sets out key areas in which urgent action is needed to address maternal and infant mortality and improve the health of women and children. The Global Strategy’s objectives, guiding principles, and recommendations provide a good starting point around which civil society organizations can be mobilized to press for stronger action on women’s and children’s health issues and to meet or exceed the minimum targets established by the Millennium Development framework.

participants of the 60th session of the who Regional committee for Europe held september

13-16, 2010, at moscow, Russia.

Nepal Core GrouppRoFEssoR KUmUD K. KaFLE

Activities

• INRUD/Nepal conducted training of trainers for Monitoring and Supervision for Drug Use and Management, organized by the Department of Health Services, Ministry of Health, for health workers of all 75 districts of Nepal in April 2010

• Participated in the first district-level peer-group discussion in the Kailali district in May 2010 that consisted of presentations on the prescribing practices and availability of drugs; presentations were made by those in charge of the health facilities, and the discussion was conducted by the district health officer

• In October 2010, participated in the workshop Dashboard to Decision Making on distribution of long-lasting insecticide nets and behavior-change communication in the districts with malaria programs supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Member Achievements

• Dr. K. K. Kafle presented a protocol entitled Rational Use of Medicines: Protocol for Situation Analysis at National, Institutional, and Community Levels at the intercountry meeting Promoting Rational Use of Medicines (South-East Asia Regional Office/WHO, July 2010)

• Dr. K. K. Kafle gave a talk entitled Pharma-covigilance in Nepal: the Past, the Present, and the Future at the Indo-Nepal Symposium on Synergising Pharmacovigilance in South Asian Countries (B. P. Koirala Institute of Health Sciences, Dharan, Nepal, September 2010)

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16INRUD News, January 2011

group reports

Impact of INRUD/Nepal

• INRUD/Nepal is a partner for the program Monitoring and Supervision for Drug Use and Management organized by the Management Division, Department of Health Services, Ministry of Health

• INRUD/Nepal conducted a training course for drug sellers on malaria prevention, diagnosis, and treatment for two years (2009 and 2010) as a sub-recipient of The Global Fund

Nigeria Core Groupprofessor a. F. b. mabadeje

The general meeting of INRUD Nigeria took place in Lagos on September 29, 2010, and was well attended by members from various parts of the country. The meeting was chaired by Professor A. O. Isah, who discussed plans for ICIUM 2011 to ensure effective participation from Nigeria. Professor Isah also discussed implementation strategies for INRUD Nigeria activities for 2011.

Activities

Dr. Oreagba and his team are carrying out active surveillance of antiretrovirals at the Lagos University Teaching Hospital HIV Clinic, which is a follow up to an earlier retrospective pharmacoepidemiological study of antiretrovirals in the same clinic.

Mrs. Lawal, chairperson of the Drug Information Centre of the Association of Community Pharmacists of Nigeria, conducted a training program to acquaint secondary school students of Trinity International College, Ofada, Ogun State, Southwest Nigeria, on the rational use of medicines.

Dr. Akoria conducted a city-wide survey of randomly selected households in Benin City, in addition to a survey of the antenatal clinics of the state-run Central Hospital and the University of Benin Teaching Hospital. The aim was to assess the uptake of insecticide-treated bed nets for the prevention of malaria and artemisinin-based combination therapies for the treatment of malaria among household members, children under age five, and pregnant women. The study began in December 2009 and was completed in June 2010.

Conferences and Workshops

Dr. Aina attended the 8th Annual Conference for the International Society for the Prevention of

17INRUD News, January 2011

Tobacco-Induced Diseases in Boston, MA, USA, September 29 to October 1, 2010. She presented a paper titled Knowledge of Tobacco Policy and Willingness to be Involved in Tobacco Cessation Among Pharmacy Students at Niger Delta University, South, South Nigeria.

Professor Isah and a team of INRUD members (Drs. Oreagba, Olowofela, Ogunleye, Ogundele, Enwere, Pharm Adekoya, Garnet, Umar, and others) attended the 16th World Congress of Basic and Clinical Pharmacology held in Copenhagen, Denmark, July 17–23, 2010. Professor Isah chaired a session and presented a paper titled Specific Features of Medicines Safety and Pharmacovigilance in Africa.

Drs. Akoria and Oreagba attended the 26th International Conference on Pharmacoepide-miology and Therapeutic Risk Management in Brighton, UK, August 19–22, 2010. The posters they presented were titled Effects of an Educational Intervention on the Prescribing of Antimalarial Medicines in a Nigerian Teaching Hospital (Dr. Akoria) and Pharmacoepidemiological Study of Antiretrovirals in Lagos University Teaching Hospital South West Nigeria (Dr. Oreagba).

Drs. Opara, Aina, and Oreagba served as resource persons at the West African Postgraduate College of Pharmacists Update lectures, which took place October 5–8, 2010.

Recent Publications

Uzochukwu, B. S. C.; Chiegboka, L. O.; Enwereuzo, C.; Nwosu, U.; Okorafor, D.; Onwujekwe, O. E.; Uguru, N. P.; Sibeudu, F. T.; Ezeoke, O. P. (2010); Examining Appropriate Diagnosis and Treatment of Malaria: Availability and Use of Rapid Diagnostic Tests and Artemisinin-Based Combination Therapy in Public and Private Health Facilities in Southeast Nigeria. BMC Public Health, 10:486

Uzochukwu, B. S. C.; Onwujekwe, O. E.; Uguru, N. P.; Ughasoro, M.D.; Ezeoke, O. P. (2010); Willingness to Pay for Rapid Diagnostic Tests for the Diagnosis and Treatment of Malaria in Southeast Nigeria: Ex Post and Ex Ante. International Journal for Equity in Health, 9:1

Oreagba, I. A.; Ogunleye, O. J.; Olayemi, S. O. (2010); The Knowledge, Perceptions, and Practice of Pharmacovigilance amongst Community Pharmacists in Lagos State, Southwest Nigeria. Pharmacoepidemiology and Drug Safety. September 15 2010 (online early view).

Busari, A.; Olayemi, S.; Oreagba, I.; Alabidun, A. (2010); Educational Intervention as a Strategy for Improving Blood Pressure Status of Market Women in Lagos, Nigeria. The Internet Journal of Health, 11(1)

Appointments and Awards

Professor John Ohaju-Obodo has been elected Provost of the College of Medical Sciences, Delta State University, Abraka.

Dr. S. O. Olayemi was appointed Acting Head of the Department of Pharmacology University of Lagos, Lagos.

Dr. O. A. Abosede was appointed Chairman of the Lagos State Primary Health Care Board, Lagos.

Dr. Bukky Dada successfully defended her PhD thesis titled Access, Quality, and Use of Generic Drugs in Health Facilities in Lagos State in September 2010.

CondolencesThe members of INRUD Nigeria sympathize with Dr. Ogori Taylor and family on the death of her husband.

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Methods: Questionnaire was used to interview randomly selected health care providers about the technical quality of their malaria treatment services. Exit polls were used to obtain information about perceived quality from consumers. A socio-economic status (SES) index and comparison of data between urban and rural areas was used to examine socio-economic status and geographic differences in quality of services.

Results: The lowest technical quality of services was found from patent medicine dealers. Con-versely, public and private hospitals as well as primary health care centres had the highest quality of services. Householders were least satisfied with quality of services of patent medicine dealers and pharmacy shops and were mostly satisfied with services rendered by public and private hospitals. The urbanites were more satisfied with the overall quality of services than the rural dwellers.Conclusion: These findings provide areas for interventions to equitably improve the quality of malaria treatment services, especially for patent medicine dealers and pharmacy shops, that are two of the most common providers of malaria treatment especially with the current change of first line drugs from the relatively inexpensive drugs to the expensive artemisinin-based combination therapy, so as to decrease inappropriate drug prescribing, use, costs and resistance to artemisinin-based combination therapy.

Improving quality of malaria treatment services: assessing inequities in consumers’ perceptions and providers’ behaviour in Nigeria*obinna onwujekwe1,2, Eric obikeze1,2, benjamin Uzochukwu1,2,3, Ijeoma okoronkwo1,4 and ogochukwu c. onwujekwe5 1Department of Health Administration and Management; 2Health Policy Research Group, Department of Pharmacology and Therapeutics; 3Department of Community Medicine; and 4Department of Nursing Sciences, College of Medicine, University of Nigeria, Enugu-Campus, Nigeria; and 5Department of Pharmacy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria

International Journal for Equity in Health 2010, 9:22doi:10.1186/1475-9276-9-22

The electronic version of this article is the complete one and can be found online at http://www.equityhealthj.com/content/9/1/22

© 2010 Onwujekwe et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (http://creativecommons.org/licenses/by/2.0).

AbstractBackground: Information about quality of malaria treatment services of different health care providers is needed to know how to improve the treatment of malaria since inappropriate service provision leads to increased burden of malaria. Hence, the study determined the technical and perceived quality of malaria treatment services of different types of providers in three urban and three rural areas in southeast Nigeria.

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Most Mothers Lack the Knowledge on How to Prepare and Give Doses of Ampicillin-Cloxacillin Dry Syrup to their Babiesmoses Iorngurum

Pediatric researchers at the University of Lagos, Nigeria, have observed for the first time (worldwide) that too few mothers in an urban setting demonstrated a real capacity to correctly reconstitute and accurately measure doses of ampicillin-cloxacillin dry syrup for their babies without assistance. They investigated mothers’ knowledge and practice of reconstitution, storage, measurement of the dose, and use of the broad-spectrum antibiotic formulation often used to treat common bacterial infections in children for decades in many countries.

The 107 mothers were provided ampicillin-cloxacillin dry syrup and all other requirements for reconstitution including a suitable work area at no cost. Their knowledge and skills were simultaneously assessed and corrected while they each reconstituted the syrup and measured one dose the way they would normally do at home. Only 22 (20.5 percent) knew the crucial importance of viewing the lower meniscus of water at eye level to obtain the correct volumes of their babies’ syrup. Before administering the reconstituted syrup to their babies, 24 (22.4 per-cent) did not shake the bottle immediately before measuring the dose volumes, which implied that their doses would be incorrect. These and other findings in the study have serious implications for rational use of medicines in children, particularly the development of bacterial resistance to commonly used antibiotics.

Our findings will have far-reaching impact on health care practice in general and pediatric formulations and pharmacotherapy around the world, particularly in health care systems that absolutely rely on the abilities of uneducated

mothers to administer an increasing number of pediatric oral suspensions to their children.

Moses Iorngurum was the principal investigator and is a pioneer in neonatal and pediatric clinical pharmacy in Nigeria. He is one of the lead consultants to the Ministry of Health for development of a pharmacovigilance policy for Nigeria. He worked with O. Ogunbanjo (one of his students) and with Prof. Mrs. Edna Iroha, consultant pediatrician and neonatologist. This research was presented at the 14th Annual Neonatal and Paediatric Pharmacists’ Group (http://www.nppg.scot.nhs.uk/) in Birmingham, UK, in 2008 (Arch. Dis. Child. 2009, 94:e2; http://adc.bmj.com/content/94/7/e2.extract?sid =c5818e7d-dfcf-4f52-ad62-83d14bf82a11).

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Retail pharmacies and their role in Tanzania’s malaria control program. Soft targets or partners in health? V. R. Kamat,1 D. J. NYato2 1University of British Columbia, Department of Anthropology, 2319-6303 North West Marine Drive, Vancouver, British Columbia, Canada V6T1Z1; 2University of Dodoma, Dodoma, United Republic of TanzaniaReference

Social Science and Medicine 2010; 71(3):626-633

Abstract

The retail sector has been at the center of recent policy debates concerning its role in malaria control programs in Africa. This article closely examines the perspectives of owners and managers of retail pharmacies and drug shops in Dar es Salaam toward the dominant public health discourse and practices surrounding the deployment of artemisinin-based combination therapy (ACT) as a way forward in malaria control. Drawing on fieldwork conducted between May–August 2007, and July–August 2009 involving in-depth interviews and participant observation in pharmacies and drug shops in Dar es Salaam, the article describes the social realities facing people who manage retail pharmacies,

the nature of their interactions with customers, the kinds of antimalarials they sell, and their perspective on how the new malaria treatment guidelines have affected their business. Findings suggest that for most pharmacy owners and managers, it is “business as usual” concerning the sale of conventional antimalarials, with a majority reporting that the introduction of ACT in public health facilities had not negatively affected their business. Implications of the research findings are examined in the context of proposed interventions to make pharmacy owners and managers more socially responsible and adhere to government health regulations. The article makes a case for actively involving pharmacy owners and managers in decision making processes surrounding the implementation of new treatment guidelines and training programs that have an impact on their business, social responsibility, and community health. In considering regulatory interventions, health planners must explicitly address the concern that retail pharmacies fill an important role in the country’s health care system and that the complex nexus that drives the global pharmaceutical market often governs their operations at the local level.

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Comment

pharmacies and drug shops play a key role in the delivery of health care and access to medicines in low-resource settings. the authors of this article argue that the commonly held stereotype of the african drug shop owner as a greedy profit maximizer who flaunts government regulations and provides illicit access to prescription-only medications may be too simplistic. the perspectives of this important group of care providers must be better understood if they are to play a meaningful role in public health, as they are expected to do in supporting the replacement of malaria monotherapy with acts. Using structured in-depth interviews with 80 pharmacists/shop owners in one district in Dar es salaam and participant observations in 6 shops, the authors explore the practices of shop owners in stocking antimalarials, servicing the customers who purchase them, the challenges in maintaining their business, and attitudes towards the government policy shift to acts. the picture they paint is of an environment characterized by a scarcity of jobs, low pay, minimum training, and high competition for customers. a large percentage of customers come for treatment of fever, often with a prescription. although 85 percent of shops did not stock acts at the time of the survey, respondents reported receiving requests for acts by customers, usually ones with prescriptions. however, over-the-counter sales of acts were very uncommon, in part due to the low cost, wide availability, and established trust of older products, and the volume of sales of older therapies had not been affected by the change in the government’s treatment policy. although acts are freely available in government facilities, many customers are reported to prefer the convenience, choice, and social environment of the drug shop. the authors contend that in the current economic environment, it is unrealistic to expect shop owners to undergo extensive formal training before they can manage a retail pharmacy when the rewards are so meager. they argue that regulatory programs to change retail practices have been ineffective, and that programs to train shop attendants about malaria guidelines must be tailored to the background characteristics of retailers, their formal training, work experience, and motivation to continue with their present job given its low compensation. While true, it is difficult to imagine how any programs to encourage use of ACTs for malaria can be effective without eliciting corresponding changes in awareness and preference among consumers.

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“Practical knowledge” and perceptions of antibiotics and antibiotic resistance among drugsellers in Tanzanian private drugstores

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N. VIbERg, w. KaLaLa, p. mUJINJa, g. tomsoN, c. s. LUNDboRg

Reference

BMC Infectious Disease 2010; 10:270

Abstract

Background: Studies indicate that antibiotics are sold against regulations and without prescriptions in private drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sales and dispensing practices and link them to drugseller knowledge and perceptions of antibiotics and antibiotic resistance.

Methods: Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics and resistance. Data were analyzed using mixed quantitative and qualitative methods.

Results: Of 350 interviewed exit customers, 24 percent had bought antibiotics. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough, stomachache, genital complaints, and diarrhea but not for malaria or headache. Dispensed drugs were assessed as relevant for the symptoms or disease presented in 83 percent of all cases and 51 percent for antibiotics specifically. Nonprescribed drugs were

assessed as more relevant than prescribed. The knowledge level of the drugseller was ranked as high or very high by 75 percent of the respondents. Seventy-five drugsellers from three districts participated. Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24 percent of these also said that antibiotics can be used for treating viral disease. Most (85 percent) said that sexually transmitted infections can be treated with antibiotics while 1 percent said the same about headache, 4 percent general weakness, and 3 percent ‘all diseases’. Seventy-two percent had heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical point of view with some exceptions. They gave rise to five categories and one theme: perceiving antibiotic resistance based on practical experience.

Conclusions: The drugsellers have considerable “practical knowledge” of antibiotics and a perception of antibiotic resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of antibiotics from these outlets in resource-constrained settings, their “practical knowledge” as well as their perceptions must be taken into account in order to attain rational dispensing practices.

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Comment

Rather than focusing on failure to comply with government regulation, this article focuses on potential strengths in retail drug shops in rural tanzania. Using material from closed-ended questionnaires and open-ended interviews of licensed drug shop attendants and customers in eight districts, the authors provide a window into the perceptions and expectations about antibiotic treatment and the problem of antibiotic resistance in these settings. One interesting finding, which has also been reported in other settings, is that the drugs dispensed for the two-thirds of customers who did not have a prescription were judged to be more relevant to the clinical condition for which they were purchased than the ones that were dispensed on prescription. consumer self-choice or shop attendant recommendations are often more conservative and less expensive that private practitioners. However, nearly one in four customers purchased antibiotics and these purchases were assessed to be less clinically relevant. Despite this, drug sellers displayed a relatively high level of knowledge about the indications for antibiotics and also about potential problems in their use. this suggests that there may be—in the words of the authors—a “practical knowledge” base upon which to build in these shops. because antibiotics are likely to continue to be dispensed without prescription in drug shops in rural tanzania and many other resource-constrained settings, programs to improve provider and consumer knowledge about when antibiotics are needed and especially about their dangers may help to improve appropriate use. although some small-scale interventions in drug shops have been shown to be successful (see next abstract), their effectiveness should be tested in large-scale programs implemented by ministries of health or pharmacy associations.

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Are interventions for improving the quality of services provided by specialized drug shops effective in sub-Saharan Africa? A systematic review of the literature. F. N. waFULa aND c. a. gooDmaN

Reference

International Journal of Quality in Health Care 2010; 22(4):316-323

Abstract

Purpose: We set out to determine effectiveness of interventions for improving the quality of services provided by specialized drug shops in sub-Saharan Africa.

Data sources: We searched PubMed, CAB Abstracts, Web of Science, PsycINFO, and Eldis databases and websites for organizations such as WHO and Management Sciences for Health. Finally, we searched manually through the references of retrieved articles.

Study selection: Our search strategy included randomized trials, time-series studies, and before and after studies evaluating six interventions—education, peer review, reorganizing administrative structures, incentives, regulation, and legislation.

Data extraction: We extracted information on design features, participants, interventions, and outcomes assessed studies for methodological quality and extracted results, all using uniform checklists.

Results of data synthesis: We obtained 10 studies, all implementing educational interventions. Out-come measures were heterogeneous and included knowledge, communication, and dispensing practices. Education improved knowledge across studies, but gave mixed results on communication between sellers and clients, dispensing of appropriate treatments, and referring of patients to health facilities. Profit incentives appeared to constrain behavior change in certain instances, although cases of shops adopting practices at the expense of sales revenue were also reported.

Conclusion: Evidence suggests that knowledge and practices of pharmacies and drug shops can be improved across a range of diseases and countries/regions, although variations were reported across studies. Profit incentives appear to bear some influence on the level of success of interventions. More work is required to extend the geographical base of evidence, investigate cost-effectiveness, and evaluate sustainability of interventions over periods longer than one year.

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Comment

The authors systematically searched for studies examining the effects of a range of different types of interventions in african retail pharmacy settings; but despite identifying over 500 candidate articles, only 10 met study inclusion criteria. this indicates a critical gap in knowledge about strategies to improve the quality of dispensing in this important health care setting, which provides access to essential medicines for a large proportion of Africa’s population. Furthermore, all 10 studies examined educational interventions directed primarily at owners and shop attendants (although a few studies included supportive patient-oriented materials). First, although it is encouraging that the studies found that education can be effective in improving knowledge and dispensing practices for several health conditions, the efficacy in these settings of other intervention approaches included in the authors’ typology (e.g., feedback, peer support, regulatory enforcement) must be explored. Some of these have been studied to a limited extent in other regions, but whether these approaches would be successful in africa is an open question. second, given that the decision to seek care in retail shops lies primarily with consumers and that much of what transpires in the sales encounter is heavily influenced by consumer preference and choice, the efficacy of different approaches to educate consumers about appropriate purchasing of medicines also needs to be examined. This is certainly relevant as governments try to shift the treatment of choice for malaria to act or in national efforts to reduce antibiotic use and resistance. Until consumers can use their feet and their purchasing power to leverage practice, the extent of long-term improvements in retail drug dispensing in Africa is likely to be limited by the economic forces that currently drive behavior in these settings.

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b. waNINg, J. maDDIX, L. soUcY

Department of Family Medicine, Boston University School of Medicine, One Boston Medical Center Place, Dowling 5 South, Boston, MA 02118, USA. bwaning@bu.edu

Reference

BMC Health Services Research 2010; 10:205.

Abstract

Background: Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature, despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and “reasonable” medicine price goals and strategic initiatives to reach them.

Methods: We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits, and medicine mark-ups during establishment and maintenance periods (October 2004–December 2007).

Results: Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with less than 25,000 USD on the basis of governmental

resource-sharing. The network operated at break-even profit, leaving little room to lower medicine prices and mark-ups. Medicine mark-ups needed for sustainability were greater than originally envisioned by network administration. In 2005, 55 percent, 35 percent, and 10 percent of the network’s top 50 products revealed mark-ups of less than 50 percent, 50–99 percent, and greater than 100 percent, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs. By 2007, only 19 percent and 46 percent of products revealed mark-ups of less than 50 percent and 50–99 percent, respectively, and 35 percent of products revealed mark-ups greater than 100 percent. In 2007, medicine mark-ups varied substantially across these products, ranging from 32 percent to 244 percent. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies.

Conclusion: Pharmacy networks can be established in hard-to-reach regions with little funding by using public–private partnerships and resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear excessive, but are likely necessary for pharmacy viability. Pharmacy financial data is available in remote settings and can be used towards determination of reasonable medicine price goals. Health systems researchers must document the positive and negative financial experiences of pharmacy initiatives to inform future projects and advance access to medicines’ goals.

Balancing medicine prices and business sustainability: Analyses of pharmacy costs, revenues, and profit shed light on retail medicine mark-ups in rural Kyrgyzstan

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Comment

although set in rural Kyrgyzstan rather than africa, this insightful and revealing study sheds light on the economic realities of running a sustainable retail operation in a very low-resource setting. Retail drug shop owners are often accused of price gouging and profiteering. Mark-ups of 100 percent or more on sales of essential medicines are seen as excessively high. This carefully conducted study demonstrates that in a network of not-for-profit retail shops operating at a break-even level, 35 percent of the most commonly sold medicines had mark-ups of 100 percent or more. the reasons for high mark-ups were twofold—low customer volume and high, fixed, recurrent costs (e.g., salaries, transport, and inventory). As the authors point out, if these shops were run for profit, mark-ups would need to be even higher to make the operation sustainable, because of the need to cover additional costs, including rent, overhead, and profit. Similar studies are urgently needed in urban and rural africa, where the factors that drive costs are likely to be quite different from those in central asia. Until we develop a deeper understanding of the economic realities of private retail drug shops, efforts to increase affordability of essential medicines or improve their dispensing are likely to founder.

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Advances in Health Economics and Health Services Research Encinosa WE, Bernard D, Dor A. Does prescription drug adherence reduce hospitalization and costs? The case of diabetes. Adv Health Econ Health Serv Res 2010; 22:151-173.

American Journal of Emergency MedicineHill PM, Rothman R, Saheed M, Deruggiero K, Hsieh YH, Kelen GD. A comprehensive approach to achieving near 100% compliance with The Joint Commission Core Measures for pneumonia antibiotic timing. Am J Emerg Med 2010 Jul 14. [Epub ahead of print].

American Journal of Managed CareGibson TB, Song X, Alemayehu B, Wang SS, Waddell JL, Bouchard JR, Forma F. Cost sharing, adherence, and health outcomes in patients with diabetes. Am J Manag Care 2010; 16(8):589-600.

Pittman DG, Tao Z, Chen W, Stettin GD. Antihypertensive medication adherence and subsequent health care utilization and costs. Am J Manag Care 2010; 16(8):568-576.

Patel H, Toe DC, Burke S, Rasu RS. Anticonvulsant use after formulary status change for brand-name second-generation anticonvulsants. Am J Manag Care 2010; 16(8):e197-e204.

Tjia J, Field TS, Garber LD, Donovan JL, Kanaan AO, Raebel MA, Zhao Y, Fuller JC, Gagne SJ, Fischer SH, and Gurwitz JH. Development and pilot testing of guidelines to monitor high-risk medications in the ambulatory setting. Am J Manag Care 2010; 16(7):489-496.

Rosenzweig JL, Taitel MS, Norman GK, Moore TJ, Turenne W, Tang P. Diabetes disease management in Medicare Advantage reduces hospitalizations and costs. Am J Manag Care 2010; 16(7):e157-e162.

Aubert RE, Yao J, Xia F, Garavaglia SB. Is there a relationship between early statin compliance and a reduction in health care utilization? Am J Manag Care 2010; 16(6):459-466.

Margolis JM, Cao Z, Onukwugha E, Sanchez RJ, Alvir J, Joshi AV, Mullins CD. Health care utilization and cost effects of prior authorization for Pregabalin in commercial health plans. Am J Manag Care 2010; 16(6):447-456.

Orrico KB, Lin JK, Wei A, Yue H. Clinical consequences of disseminating the rosiglitazone FDA safety warning. Am J Manag Care 2010; 16(5):e111-e116.

Annales de cardiologie et d’angéiologie Ghozzi H, Kassis M, Hakim A, Sahnoun Z, Abderrahmen A, Abbes R, Maalej S, Hammami S, Hajkacem L, Zeghal K. [Medication adherence of a sample of hypertensive patients in the region of Sfax (Tunisia)]. Ann Cardiol Angeiol (Paris) 2010; 59(3):131-137.

Annals of Family MedicineHartung DM, Evans D, Haxby DG, Kraemer DF, Andeen G, Fagnan LJ. Effect of drug sample removal on prescribing in a family practice clinic. Ann Fam Med 2010; 8(5):402-409.

Annals of PharmacotherapyManias E, Williams A. Medication adherence in people of culturally and linguistically diverse backgrounds: a meta-analysis. Ann Pharmacother 2010; 44(6):964-982.

Kane-Gill SL, Van Den Bos J, Handler SM. Adverse drug reactions in hospital and ambulatory care settings identified using a large administrative database. Ann Pharmacother 2010; 44(6):983-993.

Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother 2010; 44(9):1410-1421.

Antimicrobial Agents and Chemotherapy Willemsen I, Cooper B, van Buitenen C, Winters M, Andriesse G, Kluytmans J. Improving quinolone use in hospitals by using a bundle of interventions in an interrupted time series analysis. Antimicrob Agents Chemother 2010; 54(9):3763-3769.

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Applied Health Economics and Health Policy Tetteh EK. Implementing differential pricing for essential medicines via country-specific bilateral negotiated discounts. Appl Health Econ Health Policy 2009; 7(2):71-89.

Marseille E, Kahn JG, Pitter C, Bunnell R, Epalatai W, Jawe E, Were W, Mermin J. The cost effectiveness of home-based provision of antiretroviral therapy in rural Uganda. Appl Health Econ Health Policy 2009; 7(4):229-243.

Archives of Internal MedicineStrom BL, Schinnar R, Aberra F, Bilker W, Hennessy S, Leonard CE, Pifer E. Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial. Arch Intern Med 2010; 170(17):1578-1583.

Tseng CW, Waitzfelder BE, Tierney EF, Gerzoff RB, Marrero DG, Piette JD, Karter AJ, Curb JD, Chung R, Mangione CM, Crosson JC, Dudley RA. Patients’ willingness to discuss trade-offs to lower their out-of-pocket drug costs. Arch Intern Med 2010; 170(16):1502-1504.

Mattison ML, Afonso KA, Ngo LH, Mukamal KJ. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch Intern Med 2010; 170(15):1331-1336.

Millett C, Everett CJ, Matheson EM, Bindman AB, Mainous AG, III. Impact of Medicare Part D on seniors’ out-of-pocket expenditures on medications. Arch Intern Med 2010; 170(15):1325-1330.

Winterstein AG, Linden S, Lee AE, Fernandez EM, Kimberlin CL. Evaluation of consumer medication information dispensed in retail pharmacies. Arch Intern Med 2010; 170(15):1317-1324.

Zhang Y, Lee BY, Donohue JM. Ambulatory antibiotic use and prescription drug coverage in older adults. Arch Intern Med 2010; 170(15):1308-1314.

Smeets HM, de Wit NJ, Zuithoff NP, van Dijk PC, van der Lee AP, Hoes AW. A health insurance company-initiated multifaceted intervention for optimizing acid-suppressing drug prescriptions in primary care: a randomized controlled trial. Arch Intern Med 2010; 170(14):1264-1268.

Onder G, Petrovic M, Tangiisuran B, Meinardi MC, Markito-Notenboom WP, Somers A, Somers A, Rajkumar C, Bernabei R, van der Cammen TJ. Development and validation of a score to assess risk of adverse drug reactions among in-hospital patients 65 years or older: the GerontoNet ADR risk score. Arch Intern Med 2010; 170(13):1142-1148.

Tamblyn R, Abrahamowicz M, Dauphinee D, Wenghofer E, Jacques A, Klass D, Smee S, Eguale T, Winslade N, Girard N, Bartman I, Buckeridge DL, Hanley JA. Influence of physicians’ management and communication ability on patients’ persistence with antihypertensive medication. Arch Intern Med 2010; 170(12):1064-1072.

Stafford RS, Bartholomew LK, Cushman WC, Cutler JA, Davis BR, Dawson G, Einhorn PT, Furberg CD, Piller LB, Pressel SL, Whelton PK; ALLHAT Collaborative Research Group. Impact of the ALLHAT/JNC7 Dissemination Project on thiazide-type diuretic use. Arch Intern Med 2010; 170(10):851-858.

Beijing Da Xue Xue Bao Yuan YL, Yu BZ, Jiang SW, Wang T, Lv J, Tao QS. [Study of an adherence rating score system for tuberculosis patients in China]. Beijing Da Xue Xue Bao 2010; 42(3):299-303.

BMC Cardiovascular Disordersvan Mourik MS, Cameron A, Ewen M, Laing RO. Availability, price and affordability of cardiovascular medicines: a comparison across 36 countries using WHO/HAI data. BMC Cardiovasc Disord 2010; 10:25.

BMC Clinical PharmacologyTimonen J, Bengtstrom M, Karttunen P, Ahonen R. The impact of generic substitution on the activities of pharmaceutical companies - a survey from the companies’ perspective one year and five years after the introduction of generic substitution in Finland. BMC Clin Pharmacol 2010; 10(1):15.

30INRUD News, January 2011

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BMC Health Services Research Freund T, Kayling F, Miksch A, Szecsenyi J, Wensing M. Effectiveness and efficiency of primary care based case management for chronic diseases: rationale and design of a systematic review and meta-analysis of randomized and non-randomized trials [CRD32009100316]. BMC Health Serv Res 2010; 10:112.

Kuo RN, Lai MS. Comparison of Rx-defined morbidity groups and diagnosis- based risk adjusters for predicting health care costs in Taiwan. BMC Health Serv Res 2010; 10:126.

Wettermark B, Persson ME, Wilking N, Kalin M, Korkmaz S, Hjemdahl P, Godman B, Petzold M, Gustafsson LL; Regional Drug Expert Consortium in Stockholm County Council.

Forecasting drug utilization and expenditure in a metropolitan health region. BMC Health Serv Res 2010; 10:128.

Martirosyan L, Arah OA, Haaijer-Ruskamp FM, Braspenning J, Denig P. Methods to identify the target population: implications for prescribing quality indicators. BMC Health Serv Res 2010; 10:137.

Paniz VM, Fassa AG, Maia MF, Domingues MR, Bertoldi AD. Measuring access to medicines: a review of quantitative methods used in household surveys. BMC Health Serv Res 2010; 10:146.

Soufi G, Belayachi J, Himmich S, Ahid S, Soufi M, Zekraoui A, Abouqal A. Patient satisfaction in an acute medicine department in Morocco. BMC Health Serv Res 2010; 10:149.

Adamski J, Godman B, Ofierska-Sujkowska G, Osinska B, Herholz H, Wendykowska K, Laius O, Jan S, Sermet C, Zara C, Kalaba M, Gustafsson R, Garuolienè K, Haycox A, Garattini S, Gustafsson LL. Risk sharing arrangements for pharmaceuticals: potential considerations and recommendations for European payers. BMC Health Serv Res 2010; 10:153.

Schmittdiel JA, Steers N, Duru OK, Ettner SL, Brown AF, Fung V, Ettner SL, Brown AF, Fung V, Hsu J, Quiter E, Tseng CW, Mangione CM. Patient-provider communication regarding drug costs in Medicare Part D beneficiaries with diabetes: a TRIAD Study. BMC Health Serv Res 2010; 10:164.

Sauceda-Valenzuela AL, Wirtz VJ, Santa-Ana-Tellez Y, de la Luz Kageyama-Escobar. Ambulatory health service users’ experience of waiting time and expenditure and factors associated with the perception of low quality of care in Mexico. BMC Health Serv Res 2010; 10:178.

Waning B, Maddix J, Soucy L. Balancing medicine prices and business sustainability: analyses of pharmacy costs, revenues and profit shed light on retail medicine mark-ups in rural Kyrgyzstan. BMC Health Serv Res 2010; 10:205.

Sunaert P, Bastiaens H, Nobels F, Feyen L, Verbeke G, Vermeire E, De Maeseneer J, Willems S, De Sutter A. Effectiveness of the introduction of a Chronic Care Model-based program for type 2 diabetes in Belgium. BMC Health Serv Res 2010; 10:207.

Chen W, Tang S, Sun J, Ross-Degnan D, Wagner AK. Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces. BMC Health Serv Res 2010; 10:211.

Sychareun V, Phongsavan K, Hansana V, Phengsavanh A. Policy maker and provider knowledge and attitudes regarding the provision of emergency contraceptive pills within Lao PDR. BMC Health Serv Res 2010; 10:212.

Hsiao FY, Tsai YW, Huang WF. Price regulation, new entry, and information shock on pharmaceutical market in Taiwan: a nationwide data-based study from 2001 to 2004. BMC Health Serv Res 2010; 10:218.

Wang W, Fu C, Zhuo H, Luo J, Xu B. Factors affecting costs and utilization of type 2 diabetes health care: a cross-sectional survey among 15 hospitals in urban China. BMC Health Serv Res 2010; 10:244.

31INRUD News, January 2011

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Mc Namara KP, George J, O’Reilly SL, Jackson SL, Peterson GM, Howarth H, Bailey MJ, Duncan G, Trinder P, Morabito E, Finch J, Bunker S, Janus E, Emery J, Dunbar JA.

Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study. BMC Health Serv Res 2010; 10:264.

Stepurko T, Pavlova M, Gryga I, Groot W. Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Serv Res 2010; 10:273.

Phuong HL, Nga TT, Giao PT, Hung lQ, Binh TQ, Nam NV, Nagelkerke N, de Vries PJ.

Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam. BMC Health Serv Res 2010; 10:275.

BMC Infectious DiseasesHadi U, van den Broek P, Kolopaking EP, Zairina N, Gardjito W, Gyssens IC. Cross-sectional study of availability and pharmaceutical quality of antibiotics requested with or without prescription (Over The Counter) in Surabaya, Indonesia. BMC Infect Dis 2010; 10:203.

Viberg N, Kalala W, Mujinja P, Tomson G, Lundborg CS. “Practical knowledge” and perceptions of antibiotics and antibiotic resistance among drugsellers in Tanzanian private drugstores. BMC Infect Dis 2010; 10:270.

BMC International Health and Human RightsSakisaka K, Jimba M, Hanada K. Changing poor mothers’ care-seeking behaviors in response to childhood illness: findings from a cross-sectional study in Granada, Nicaragua. BMC Int Health Hum Rights 2010; 10:10.

BMC Medical Informatics and Decision MakingKo GT, So WY, Tong PC, Le Coguiec F, Kerr D, Lyubomirsky G, Tamesis B, Wolthers T, Nan J, Chan J. From design to implementation--the Joint Asia Diabetes Evaluation (JADE) program: a descriptive report of an electronic web-based diabetes management program. BMC Med Inform Decis Mak 2010; 10:26.

Lamy JB, Ebrahiminia V, Riou C, Seroussi B, Bouaud J, Simon C, Dubois S, Butti A, Simon G, Favre M, Falcoff H, Venot A. How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines. BMC Med Inform Decis Mak 2010; 10:31.

BMC PediatricsWaning B, Diedrichsen E, Jambert E, Barnighausen T, Li Y, Pouw M, Moon S. The global pediatric antiretroviral market: analyses of product availability and utilization reveal challenges for development of pediatric formulations and HIV/AIDS treatment in children. BMC Pediatr 2010; 10(1):74.

BMC Public HealthMaher D. Re-thinking global health sector efforts for HIV and tuberculosis epidemic control: promoting integration of programme activities within a strengthened health system. BMC Public Health 2010; 10:394.

Asante KP, Abokyi L, Zandoh C, Owusu R, Awini E, Sulemana A, Amenga-Etego S, Adda R, Boahen O, Segbaya S, Mahama E, Bart-Plange C, Chandramohan D, Owusu-Agyei S. Community perceptions of malaria and malaria treatment behaviour in a rural district of Ghana: implications for artemisinin combination therapy. BMC Public Health 2010; 10:409.

Uzochukwu BS, Chiegboka LO, Enwereuzo C, Nwosu U, Okorafor D, Onwujekwe OE, Uguru NP, Sibeudu FT, Ezeoke OP. Examining appropriate diagnosis and treatment of malaria: availability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilities in south east Nigeria. BMC Public Health 2010; 10:486.

32INRUD News, January 2011

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Bird D, Oldenburg B, Cassimatis M, Russell A, Ash S, Courtney MD, Scuffham PA, Stewart I, Wootton R, Friedman RH. Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project): study protocol. BMC Public Health 2010; 10(1):599.

Sapkota AR, Coker ME, Rosenberg Goldstein RE, Atkinson NL, Sweet SJ, Sopeju PO, Ojo MT, Otivhia E, Ayepola OO, Olajuyigbe OO, Shireman L, Pottinger PS, Ojo KK. Self-medication with antibiotics for the treatment of menstrual symptoms in southwest Nigeria: a cross-sectional study. BMC Public Health 2010; 10(1):610.

British Journal of Clinical Pharmacology Rawlins M, Barnett D, Stevens A. Pharmacoeconomics: NICE’s approach to decision-making. Br J Clin Pharmacol 2010; 70(3):346-349.

Edlin R, Round J, Hulme C, McCabe C. Cost-effectiveness analysis and efficient use of the pharmaceutical budget: the key role of clinical pharmacologists. Br J Clin Pharmacol 2010; 70(3):350-355.

Stewart D, Cunningham IT, Hansford D, John D, McCaig D, McLay J. General practitioners’ views and experiences of over-the-counter simvastatin in Scotland. Br J Clin Pharmacol 2010; 70(3):356-359.

Towse A. Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong? Br J Clin Pharmacol 2010; 70(3):360-366.

British Journal of PsychiatrySiskind D, Araya R, Kim J. Cost-effectiveness of improved primary care treatment of depression in women in Chile. Br J Psychiatry 2010; 197(4):291-296.

British Medical JournalLester H, Schmittdiel J, Selby J, Fireman B, Campbell S, Lee J, Whippy A, Madvig P. The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators. BMJ 2010; 340:c1898.

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010; 340:c2096.

Cumming J, Mays N, Daube J. How New Zealand has contained expenditure on drugs. BMJ 2010; 340:c2441.

Ferner RE, Lenney W, Marriott JF. Controversy over generic substitution. BMJ 2010; 340:c2548.

Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L, Gupta R, Bharathi AV, Vaz M, Kurpad AV, Smith GD, Ben-Shlomo Y, Ebrahim S. Sociodemographic patterning of non-communicable disease risk factors in rural India: a cross sectional study. BMJ 2010; 341:c4974.

So A, Furlong M, Heddini A. Globalisation and antibiotic resistance. BMJ 2010; 341:c5116.

Bulletin of The World Health OrganizationMendis S, Johnston SC, Fan W, Oladapo O, Cameron A, Faramawi MF. Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Bull World Health Organ 2010; 88(6):412-419.

Greene JA. When did medicines become essential? Bull World Health Organ 2010; 88(7):483.

Cadernos de saúde públicaDal Pizzol Tda S, Trevisol DJ, Heineck I, Flores LM, Camargo AL, Köenig A, Torres IL, Kadri MC, Monreal MT, Melo AM, Ferreira MB. [Adherence to essential medicines in cities from three Brazilian states]. Cad Saude Publica 2010; 26(4):827-836.

Ciência y saúde coletivaNaves Jde O, Castro LL, Carvalho CM, Merchan-Hamann E. [Self-medication: a qualitative approach of its motivations]. Cien Saude Colet 2010; 15 Suppl 1:1751-1762.

33INRUD News, January 2011

Clinical Infectious Diseasesd’Acremont V, Malila A, Swai N, Tillya R, Kahama-Maro J, Lengeler C, Genton B. Withholding antimalarials in febrile children who have a negative result for a rapid diagnostic test. Clin Infect Dis 2010; 51(5):506-511.

Clinical Research in CardiologyWong MC, Jiang JY, Su X, Wang H, Tang JL, Griffiths SM. Individuals at risk of beta-blocker discontinuation: a cohort study in 19,177 Chinese patients. Clin Res Cardiol 2010; 99(5):277-284.

Current Drug SafetyTalevi A. The new patient and responsible self-medication practices: a critical review. Curr Drug Saf 2010; 5(4):342-353.

Current Medical Research and OpinionShi L, Zhao Y, Fonseca V, Ascher-Svanum H, Chiang YJ, Winstead D. Health care resource utilization, adherence and persistence with antipsychotic therapy among schizophrenia patients with vs. without pre-existing metabolic syndrome. Curr Med Res Opin 2010; 26(10):2499-2506.

Nichols GA, Conner C, Brown JB. Initial nonadherence, primary failure and therapeutic success of metformin monotherapy in clinical practice. Curr Med Res Opin 2010; 26(9):2127-2135.

Yang W, Chang J, Kahler KH, Fellers T, Orloff J, Wu EQ, Bensimon AG. Evaluation of compliance and health care utilization in patients treated with single pill vs. free combination antihypertensives. Curr Med Res Opin 2010; 26(9):2065-2076.

Diabetes Research and Clinical PracticeAl-Qazaz HK, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky DE. The eight-item Morisky Medication Adherence Scale MMAS: Translation and validation of the Malaysian version. Diabetes Res Clin Pract 2010.

Drugs and Aging Lampela P, Hartikainen S, Lavikainen P, Sulkava R, Huupponen R. Effects of medication assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: a population-based intervention study. Drugs Aging 2010; 27(6):507-521.

East African Journal of Public Health Ajayi IO, Falade CO, Kale OO. An assessment of accuracy of mothers’ presumptive diagnosis of fever at home in southwest Nigeria: evidence for switch to parasite-based diagnostic test. East Afr J Public Health 2009; 6(3):229-234.

Eastern Mediterranean Health JournalBashrahil KA. Indicators of rational drug use and health services in Hadramout, Yemen. East Mediterr Health J 2010; 16(2):151-155.

European Journal of Clinical PharmacologyCereza G, Agusti A, Pedros C, Vallano A, Aguilera C, Danes I, Vidal X, Arnau JM. Effect of an intervention on the features of adverse drug reactions spontaneously reported in a hospital. Eur J Clin Pharmacol 2010; 66(9):937-945.

Porta A, Esposito S, Menson E, Spyridis N, Tsolia M, Sharland M, Principi N. Off-label antibiotic use in children in three European countries. Eur J Clin Pharmacol 2010; 66(9):919-927.

Gjerden P, Slordal L, Bramness JG. Prescription persistence and safety of antipsychotic medication: a national registry-based 3-year follow-up. Eur J Clin Pharmacol 2010; 66(9):911-917.

Latry P, Molimard M, Begaud B, Martin-Latry K. How reimbursement databases can be used to support drug utilisation studies: example using the main French national health insurance system database. Eur J Clin Pharmacol 2010; 66(7):743-748.

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34INRUD News, January 2011

Tobaiqy M, Stewart D, Helms PJ, Bond C, Lee AJ, Bateman N, McCaig D, McLay J. A pilot study to evaluate a community pharmacy-based monitoring system to identify adverse drug reactions associated with paediatric medicines use. Eur J Clin Pharmacol 2010; 66(6):627-632.

European Journal of PediatricsMaor Y, Raz M, Rubinstein E, Derazne E, Ringel S, Roizin H, Rahav G, Regev-Yochay G; for the Israeli Judicious Antibiotic Prescription (IJAP) study group. Changing parents’ opinions regarding antibiotic use in primary care. Eur J Pediatr 2010.

Evidence-Based Mental Health Campbell LA, Kisely S. Prescribing preferred medications improves adherence in people with severe mental illness. Evid Based Ment Health 2010 Nov;13(4):108.

Expert Opinion on PharmacotherapyFontoura MS, Araujo-Neto CA, Andrade SC, Brim RV, Matutino AR, Silva CC, Santana MC, Nobre-Bastos M, Oliveira F, Barreto BB, Santos PM, Noblat L, Cardoso MR, Nascimento-Carvalho CM; PNEUMOPAC-Efficacy Study Group. Clinical failure among children with nonsevere community-acquired pneumonia treated with amoxicillin. Expert Opin Pharmacother 2010; 11(9):1451-1458.

Family PracticeDong L, Yan H, Wang D. Drug prescribing indicators in village health clinics across 10 provinces of Western China. Fam Pract 2010 Sep 27. [Epub ahead of print].

Kotwani A, Wattal C, Katewa S, Joshi PC, Holloway K. Antibiotic use in the community: what factors influence primary care physicians to prescribe antibiotics in Delhi, India? Fam Pract 2010 Jul 26. [Epub ahead of print].

Pickin M, O’Cathain A, Sampson F, Salisbury C, Nicholl J. The impact of Advanced Access on antibiotic prescribing: a controlled before and after study. Fam Pract 2010; 27(5):554-555.

Globalization and HealthWaning B, Kyle M, Diedrichsen E, Soucy L, Hochstadt J, Barnighausen T, Moon S. Intervening in global markets to improve access to HIV/AIDS treatment: an analysis of international policies and the dynamics of global antiretroviral medicines markets. Global Health 2010; 6:9.

Health Affairs (Millwood)Kesselheim AS, Outterson K. Fighting antibiotic resistance: marrying new financial incentives to meeting public health goals. Health Aff (Millwood) 2010; 29(9):1689-1696.

Shrank WH, Choudhry NK, Agnew-Blais J, Federman AD, Liberman JN, Liu J, Kesselheim AS, Brookhart MA, Fischer MA. State generic substitution laws can lower drug outlays under Medicaid. Health Aff (Millwood) 2010; 29(7):1383-1390.

Jacobson M, Earle CC, Price M, Newhouse JP. How Medicare’s payment cuts for cancer chemotherapy drugs changed patterns of treatment. Health Aff (Millwood) 2010; 29(7):1391-1399.

Davidoff AJ, Stuart B, Shaffer T, Shoemaker JS, Kim M, Zacker C. Lessons learned: who didn’t enroll in Medicare drug coverage in 2006, and why? Health Aff (Millwood) 2010; 29(6):1255-1263.

Health Care Management Science Gonul FF, Carter FJ. Impact of e-detailing on the number of new prescriptions. Health Care Manag Sci 2010; 13(2):101-111.

Health and Human Rights Mok EA. International assistance and cooperation for access to essential medicines. Health Hum Rights 2010; 12(1):73-81.

Health PolicyYu X, Li C, Shi Y, Yu M. Pharmaceutical supply chain in China: current issues and implications for health system reform. Health Policy 2010; 97(1):8-15.

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35INRUD News, January 2011

Carlson JJ, Sullivan SD, Garrison LP, Neumann PJ, Veenstra DL. Linking payment to health outcomes: a taxonomy and examination of performance-based reimbursement schemes between health care payers and manufacturers. Health Policy 2010; 96(3):179-190.

Ahmed HM, Mitchell M, Hedt B. National implementation of Integrated Management of Childhood Illness (IMCI): policy constraints and strategies. Health Policy 2010; 96(2):128-133.

Lockhart M, Babar ZU, Garg S. Evaluation of policies to support drug development in New Zealand. Health Policy 2010; 96(2):108-117.

Hiligsmann M, Rabenda V, Bruyere O, Reginster JY. The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients. Health Policy 2010; 96(2):170-177.

Onwujekwe O, Dike N, Uzochukwu B, Ezeoke O. Informal payments for health care: differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria. Health Policy 2010; 96(1):72-79.

Health Policy and PlanningRiyarto S, Hidayat B, Johns B, Probandari A, Mahendradhata Y, Utarini A, Trisnantoro L, Flessenkaemper S. The financial burden of HIV care, including antiretroviral therapy, on patients in three sites in Indonesia. Health Policy Plan 2010; 25(4):272-282.

Health Services ResearchKaraca-Mandic P, Joyce GF, Goldman DP, Laouri M. Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis. Health Serv Res 2010; 45(5 Pt 1):1227-1250.

Zhang Y, Donohue JM, Lave JR, Gellad WF. The impact of Medicare Part D on medication treatment of hypertension. Health Serv Res 2010 Sep 28 [Epub ahead of print].

Chen TT, Chung KP, Lin IC, Lai MS. The unintended consequence of diabetes mellitus Pay-for-Performance (P4P) Program in Taiwan: Are patients with more comorbidities or more severe conditions likely to be excluded from the P4P Program? Health Serv Res 2010 Sep 28 [Epub ahead of print].

Fagan PJ, Schuster AB, Boyd C, Marsteller JA, Griswold M, Murphy SM, Dunbar L, Forrest CB. Chronic care improvement in primary care: evaluation of an integrated pay-for-performance and practice-based care coordination program among elderly patients with diabetes. Health Serv Res 2010 Sep 17. [Epub ahead of print].

Wang J, Mullins CD, Brown LM, Shih YC, Dagogo-Jack S, Hong SH, Cushman WC. Disparity implications of Medicare eligibility criteria for medication therapy management services. Health Serv Res 2010; 45(4):1061-1082.

Implementation ScienceLuitjes SH, Wouters MG, Franx A, Scheepers HC, Coupe VM, Wollersheim H, Steegers EA, Heringa MP, Hermens RP, van Tulder MW. Study protocol: Cost effectiveness of two strategies to implement the NVOG guidelines on hypertension in pregnancy: An innovative strategy including a computerised decision support system compared to a common strategy of professional audit and feedback, a randomized controlled trial. Implement Sci 2010; 5:68.

Indian Journal of Community MedicineSodani PR, Kumar RK, Srivastava J, Sharma L. Measuring patient satisfaction: a case study to improve quality of care at public health facilities. Indian J Community Med 2010; 35(1):52-56.

Indian Journal of PharmacologyKotwani A. Access to essential medicines and standard treatment for chronic diseases. Indian J Pharmacol 2010; 42(3):127-128.

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36INRUD News, January 2011

Infection Control and Hospital EpidemiologyApisarnthanarak A, Yatrasert A, Mundy LM. Impact of education and an antifungal stewardship program for candidiasis at a Thai tertiary care center. Infect Control Hosp Epidemiol 2010; 31(7):722-727.

International Journal of Clinical Pharmacology and TherapeuticsOlanrewaju TO, Aderibigbe A, Busari OA, Sanya EO. Antihypertensive drug utilization and conformity to guidelines in a sub-Saharan African hypertensive population. Int J Clin Pharmacol Ther 2010; 48(1):68-75.

International Journal of Circumpolar Health Bhattacharyya O, Harris S, Zwarenstein M, Barnsley J. Controlled trial of an intervention to improve cholesterol management in diabetes patients in remote Aboriginal communities. Int J Circumpolar Health 2010; 69(4):333-343.

International Journal of Diabetes in Developing CountriesMorowatisharifabad MA, Mahmoodabad SS, Baghianimoghadam MH, Tonekaboni NR. Relationships between locus of control and adherence to diabetes regimen in a sample of Iranians. Int J Diabetes Dev Ctries 2010; 30(1):27-32.

Salam A. Educational program for patients with type-1 diabetes mellitus receiving free monthly supplies of insulin improves knowledge and attitude, but not adherence. Int J Diabetes Dev Ctries 2010; 30(2):105.

International Journal for Equity in Health Onwujekwe O, Obikeze E, Uzochukwu B, Okoronkwo I, Onwujekwe OC. Improving quality of malaria treatment services: assessing inequities in consumers’ perceptions and providers’ behaviour in Nigeria. Int J Equity Health 2010; 9:22.

International Journal of Evidence-Based Health careMedves J, Godfrey C, Turner C, Paterson M, Harrison M, Mackenzie L, Durando P. Systematic review of practice guideline dissemination and implementation strategies for health care teams and team-based practice. Int J Evid Based Healthc 2010; 8(2):79-89.

International Journal of Infectious Diseases Bigogo G, Audi A, Aura B, Aol G, Breiman RF, Feikin DR. Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates. Int J Infect Dis 2010.

International Journal of Nursing StudiesChiu CW, Wong FK. Effects of 8 weeks sustained follow-up after a nurse consultation on hypertension: a randomised trial. Int J Nurs Stud 2010; 47(11):1374-1382.

International Journal of Pharmacy PracticeJames KL, Barlow D, McArtney R, Hiom S, Roberts D, Whittlesea C. Incidence, type and causes of dispensing errors: a review of the literature. Int J Pharm Pract 2009; 17(1):9-30.

International Psychogeriatrics Rodriguez E, Marquett R, Hinton L, McBride M, Gallagher-Thompson D. The impact of education on care practices: an exploratory study of the influence of “action plans” on the behavior of health professionals. Int Psychogeriatr 2010; 22(6):897-908.

International Journal for Quality in Health CareLinder JA, Schnipper JL, Tsurikova R, Volk LA, Middleton B. Self-reported familiarity with acute respiratory infection guidelines and antibiotic prescribing in primary care. Int J Qual Health Care 2010 Oct 8. [Epub ahead of print].

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37INRUD News, January 2011

Chiu YW, Weng YH, Lo HL, Shih YH, Hsu CC, Kuo KN. Impact of a nationwide outreach program on the diffusion of evidence-based practice in Taiwan. Int J Qual Health Care 2010; 22(5):430-436.

Wafula FN, Goodman CA. Are interventions for improving the quality of services provided by specialized drug shops effective in sub-Saharan Africa? A systematic review of the literature. Int J Qual Health Care 2010; 22(4):316-323.

Snyder RA, Fields W. A model for medication safety event detection. Int J Qual Health Care 2010; 22(3):179-186.

Journal of the American Academy of Nurse PractitionersLanders TF, Ferng YH, McLoughlin JW, Barrett AE, Larson E. Antibiotic identification, use, and self-medication for respiratory illnesses among urban Latinos. J Am Acad Nurse Pract 2010; 22(9):488-495.

Journal of the American Geriatrics SocietyPolinski JM, Kilabuk E, Schneeweiss S, Brennan T, Shrank WH. Changes in drug use and out-of-pocket costs associated with Medicare Part D implementation: a systematic review. J Am Geriatr Soc 2010; 58(9):1764-1779.

Journal of the American Medical AssociationPowell LH, Calvin JE, Jr., Richardson D, Janssen I, Mendes de Leon CF, Flynn KJ, Grady KL, Rucker-Whitaker CS, Eaton C, Avery E; HART Investigators. Self-management counseling in patients with heart failure: the heart failure adherence and retention randomized behavioral trial. JAMA 2010; 304(12):1331-1338.

Holmes CB, Coggin W, Jamieson D, Mihm H, Granich R, Savio P, Hope M, Ryan C, Moloney-Kitts M, Goosby EP, Dybul M. Use of generic antiretroviral agents and cost savings in PEPFAR treatment programs. JAMA 2010; 304(3):313-320.

Journal of the American Medical informatics Association Palchuk MB, Fang EA, Cygielnik JM, Labreche M, Shubina M, Ramelson HZ, Hamann C, Broverman C, Einbinder JS, Turchin A. An unintended consequence of electronic prescriptions: prevalence and impact of internal discrepancies. J Am Med Inform Assoc 2010; 17(4):472-476.

Magrabi F, Li SY, Day RO, Coiera E. Errors and electronic prescribing: a controlled laboratory study to examine task complexity and interruption effects. J Am Med Inform Assoc 2010; 17(5):575-583.

Journal of the American Pharmacists AssociationNichol MB, Knight TK, Priest JL, Wu J, Cantrell CR. Nonadherence to clinical practice guidelines and medications for multiple chronic conditions in a California Medicaid population. J Am Pharm Assoc (2003) 2010; 50(4):496-507.

Journal of Antimicrobial Chemotherapy Butler CC, Hood K, Kelly MJ, Goossens H, Verheij T, Little P, Melbye H, Torres A, Mölstad S, Godycki-Cwirko M, Almirall J, Blasi F, Schaberg T, Edwards P, Rautakorpi UM, Hupkova H, Wood J, Nuttall J, Coenen S. Treatment of acute cough/lower respiratory tract infection by antibiotic class and associated outcomes: a 13 European country observational study in primary care. J Antimicrob Chemother 2010; 65(11):2472-2478.

McNulty CA, Francis NA. Optimizing antibiotic prescribing in primary care settings in the UK: findings of a BSAC multi-disciplinary workshop 2009. J Antimicrob Chemother 2010; 65(11):2278-2284.

Journal of Biosocial ScienceOkeke TA. Improving malaria recognition, treatment and referral practices by training caretakers in rural Nigeria. J Biosoc Sci 2010; 42(3):325-339.

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38INRUD News, January 2011

Journal of Clinical Hypertension Martin MY, Kohler C, Kim YI, Kratt P, Schoenberger YM, Litaker MS, Prayor-Patterson HM, Clarke SJ, Andrews S, Pisu M. Taking less than prescribed: medication nonadherence and provider-patient relationships in lower-income, rural minority adults with hypertension. J Clin Hypertens (Greenwich) 2010; 12(9):706-713.

Journal of Clinical NursingMaa SH, Chang YC, Chou CL, Ho SC, Sheng TF, Macdonald K, Wang Y, Shen YM, Abraham I. Evaluation of the feasibility of a school-based asthma management programme in Taiwan. J Clin Nurs 2010; 19(17-18):2415-2423.

Journal of Clinical Pharmacology Wong MC, Jiang JY, Griffiths SM. Antihypertensive drug adherence among 6408 Chinese patients on angiotensin-converting enzyme inhibitors in Hong Kong: a cohort study. J Clin Pharmacol 2010; 50(5):598-605.

Journal of Clinical Pharmacy and TherapeuticsTsuji K, Tsutani K. Approval of new drugs 1999-2007: comparison of the US, the EU and Japan situations. J Clin Pharm Ther 2010; 35(3):289-301.

Sultana G, Kapur P, Aqil M, Alam MS, Pillai KK. Drug utilization of oral hypoglycemic agents in a university teaching hospital in India. J Clin Pharm Ther 2010; 35(3):267-277.

Journal of Community Health Silver A, Figge J, Haskin DL, Pryor V, Fuller K, Lemme T, Li N, O’Brien MJ. An Asthma and Diabetes Quality Improvement Project: Enhancing Care in Clinics and Community Health Centers. J Community Health 2010 Jul 29. [Epub ahead of print].

Journal of Critical CareAmado VM, Vilela GP, Queiroz A, Jr., Amaral AC. Effect of a quality improvement intervention to decrease delays in antibiotic delivery in pediatric febrile neutropenia: A pilot study. J Crit Care 2010 Jul 7. [Epub ahead of print].

Journal of Evaluation in Clinical PracticeBhogal SK, McGillivray D, Bourbeau J, Plotnick LH, Bartlett SJ, Benedetti A, Ducharme FM. Focusing the focus group: impact of the awareness of major factors contributing to non-adherence to acute paediatric asthma guidelines. J Eval Clin Pract 2010 Sep 22. [Epub ahead of print].

Fokkens AS, Wiegersma PA, Reijneveld SA. Organization of diabetes primary care: a review of interventions that delegate general practitioner tasks to a nurse. J Eval Clin Pract 2010 Aug 26. [Epub ahead of print].

Chen CC, Wu LC, Li CY, Liu CK, Woung LC, Ko MC. Non-adherence to antibiotic prescription guidelines in treating urinary tract infection of children: a population-based study in Taiwan. J Eval Clin Pract 2010 Aug 24. [Epub ahead of print].

Barry AR, Loewen PS, de Lemos J, Lee KG. Reasons for non-use of proven pharmacotherapeutic interventions: systematic review and framework development. J Eval Clin Pract 2010 Aug 24. [Epub ahead of print].

Lin YC, Lin HC, Lin HC. Doctor characteristics and prescribing antibiotics for urinary tract infections: the experience of an Asian country. J Eval Clin Pract 2010 Aug 15. [Epub ahead of print].

Millar A, Cauch-Dudek K, Shah BR. The impact of diabetes education on blood glucose self-monitoring among older adults. J Eval Clin Pract 2010; 16(4):790-793.

Doubova SV, Mino-Leon D, Reyes-Morales H, Flores-Hernandez S, Torres-Arreola LP, Perez-Cuevas R. Effects of two educational programmes aimed at improving the utilization of non-opioid analgesics in family medicine clinics in Mexico. J Eval Clin Pract 2010; 16(4):716-723.

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39INRUD News, January 2011

Siriwardena AN, Apekey T, Tilling M, Dyas JV, Middleton H, Orner R. General practitioners’ preferences for managing insomnia and opportunities for reducing hypnotic prescribing. J Eval Clin Pract 2010; 16(4):731-737.

Kyle GJ, Nissen L, Tett S. Community pharmacy dispensing of prescription medicine sample packs: changing the business of medicine initiation? J Eval Clin Pract 2010 Jul 29. [Epub ahead of print].

Journal of General Internal MedicinePinckney RG, Helminski AS, Kennedy AG, Maclean CD, Hurowitz L, Cote E. The Effect of Medication Samples on Self-Reported Prescribing Practices: A Statewide, Cross-Sectional Survey. J Gen Intern Med 2010 Aug 31. [Epub ahead of print].

Journal of Health EconomicsBardey D, Bommier A, Jullien B. Retail price regulation and innovation: reference pricing in the pharmaceutical industry. J Health Econ 2010; 29(2):303-316.

Journal of Health Services Research and PolicyAtkins S, Biles D, Lewin S, Ringsberg K, Thorson A. Patients’ experiences of an intervention to support tuberculosis treatment adherence in South Africa. J Health Serv Res Policy 2010; 15(3):163-170.

Journal of InfectionJoung MK, Kwon KT, Kang CI, Cheong HS, Rhee JY, Jung DS, Chung SM, Lee JA, Moon SY, Ko KS, Chung DR, Lee NY, Song JH, Peck KR. Impact of inappropriate antimicrobial therapy on outcome in patients with hospital-acquired pneumonia caused by Acinetobacter baumannii. J Infect 2010; 61(3):212-218.

Journal of Infection and Public Health Dib JG, Al Tawfiq JA, Al Abdulmohsin S, Mohammed K, Jenden PD. Improvement in vancomycin utilization in adults in a Saudi Arabian Medical Center using the Hospital Infection Control Practices Advisory Committee guidelines and simple educational activity. J Infect Public Health 2009; 2(3):141-146.

Scicluna EA, Borg MA, Gur D, Rasslan O, Taher I, Redjeb SB, Elnassar Z, Bagatzouni DP, Daoud Z. Self-medication with antibiotics in the ambulatory care setting within the Euro-Mediterranean region; results from the ARMed project. J Infect Public Health 2009; 2(4):189-197.

Journal of the International AIDS SocietyWaning B, Diedrichsen E, Moon S. A lifeline to treatment: the role of Indian generic manufacturers in supplying antiretroviral medicines to developing countries. J Int AIDS Soc 2010; 13:35.

Journal of Managed Care Pharmacy Bhargava V, Greg ME, Shields MC. Addition of generic medication vouchers to a pharmacist academic detailing program: effects on the generic dispensing ratio in a physician-hospital organization. J Manag Care Pharm 2010; 16(6):384-392.

Linton A, Bacon TA, Trice S, Devine J, Cottrell L, McGinnis TJ, McAllister EB. Results from a mailed promotion of medication reviews among department of defense beneficiaries receiving 10 or more chronic medications. J Manag Care Pharm 2010; 16(8):578-592.

Journal of Medical EconomicsYu AP, Xie J, Bensimon A, Parikh K, Wu EQ, Ben Hamadi R, Blum S, Haim Erder M. Economic consequence of switching to citalopram after its generic entry for adult patients with major depressive disorder (MDD) treated with escitalopram: a 6-month retrospective study. J Med Econ 2010 Sep 29. [Epub ahead of print].

Journal of Medical Systems Chuang MH, Wang YF, Chen M, Cham TM. Effectiveness of implementation of a new drug storage label and error-reducing process on the accuracy of drug dispensing. J Med Syst 2010 Oct 15. [Epub ahead of print].

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40INRUD News, January 2011

Journal of Rheumatology Lineker SC, Husted JA. Educational interventions for implementation of arthritis clinical practice guidelines in primary care: effects on health professional behavior. J Rheumatol 2010; 37(8):1562-1569.

Journal of Tropical PediatricsChen R, Chen Y, Black S, Hao CL, Ding YF, Zhang T, Zhao GM. Antibiotic resistance patterns and serotype distribution in Streptococcus pneumoniae from hospitalized pediatric patients with respiratory infections in Suzhou, China. J Trop Pediatr 2010; 56(3):204-205.

Journal of Vector Borne Diseases Adedotun AA, Morenikeji OA, Odaibo AB. Knowledge, attitudes and practices about malaria in an urban community in south-western Nigeria. J Vector Borne Dis 2010; 47(3):155-159.

LancetRidley DB, Sanchez AC. Introduction of European priority review vouchers to encourage development of new medicines for neglected diseases. Lancet 2010; 376(9744):922-927.

Adeyi O, Atun R. Universal access to malaria medicines: innovation in financing and delivery. Lancet 2010 Oct 10. [Epub ahead of print].

Malaria JournalAlba S, Hetzel MW, Goodman C, Dillip A, Liana J, Mshinda H, Lengeler C. Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective. Malar J 2010; 9:164.

Kyabayinze DJ, Asiimwe C, Nakanjako D, Nabakooza J, Counihan H, Tibenderana JK. Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda. Malar J 2010; 9:200.

Medical CareAlexander JA, Hearld LR. The science of quality improvement implementation: developing capacity to make a difference. Med Care 2010 Sep 8. [Epub ahead of print].

Ostini R, Jackson C, Hegney D, Tett SE. How is medication prescribing ceased?: a systematic review. Med Care 2010 Oct 18. [Epub ahead of print].

Fang G, Brooks JM, Chrischilles EA. A new method to isolate local-area practice styles in prescription use as the basis for instrumental variables in comparative effectiveness research. Med Care 2010; 48(8):710-717.

Medical Care Research and Review Baig AA, Wilkes AE, Davis AM, Peek ME, Huang ES, Bell DS, Chin MH. The use of quality improvement and health information technology approaches to improve diabetes outcomes in African American and Hispanic patients. Med Care Res Rev 2010; 67(5 Suppl):163S-197S.

Médecine et maladies infectieuses Hounsa A, Kouadio L, De Mol P. [Self-medication with antibiotics obtained from private pharmacies in Abidjan, Ivory Coast]. Med Mal Infect 2010; 40(6):333-340.

Medical Principles and PracticesSaad H, Sawan S, Rashed W, Zubaid M. Influence of diabetes on the outcome of acute coronary syndrome in Kuwait. Med Princ Pract 2010; 19(2):113-117.

Ayyad S, Al Owaisheer A, Al Banwan F, Al Mejalli A, Shukkur M, Thalib L. Evidence-based practice in the use of antibiotics for respiratory tract infections in primary health centers in Kuwait. Med Princ Pract 2010; 19(5):339-343.

Médicine TropicaleMaiga D, Maiga S, Maiga MD. [Mechanism and implication of regulation of the pricing of essential medicines in the private pharmaceutical sector in Mali]. Med Trop 2010; 70(2):184-188.

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41INRUD News, January 2011

Nepal Medical College JournalKafle KK, Bhuju GB, Karkee SB, Prasad RR, Shrestha N, Shrestha AD, Das PL, Chataut BD, Daud M. An intervention improving prescribing practices and monitoring drugs availability in a district. Nepal Med Coll J 2009; 11(4):217-221.

Nigeria Quarterly Journal of Hospital Medicine Aina BA, Tayo F, Taylor O, Eniojukan JF. Antimalarial prescribing patterns in state hospitals and selected parastatal hospitals in Lagos, Nigeria. Nig Q J Hosp Med 2009; 19(1):20-26.

Patient Preference and AdherenceWilbur K, Salam SE, Mohammadi E. Patient perceptions of pharmacist roles in guiding self-medication of over-the-counter therapy in Qatar. Patient Prefer Adherence 2010; 4:87-93.

Pharmacoepidemiology and Drug SafetyQato DM, Lindau ST, Conti RM, Schumm LP, Alexander GC. Racial and ethnic disparities in cardiovascular medication use among older adults in the United States. Pharmacoepidemiol Drug Saf 2010; 19(8):834-842.

Hansen RA, Cornell PY, Ryan PB, Williams CE, Pierson S, Greene SB. Patterns in nursing home medication errors: disproportionality analysis as a novel method to identify quality improvement opportunities. Pharmacoepidemiol Drug Saf 2010; 19(10):1087-1094.

Carrasco-Garrido P, Hernández-Barrera V, López de Andrés A, Jiménez-Trujillo I, Jiménez-García R.Sex-Differences on self-medication in Spain. Pharmacoepidemiol Drug Saf 2010 Sep 24. [Epub ahead of print].

Oreagba IA, Ogunleye OJ, Olayemi SO. The knowledge, perceptions and practice of pharmacovigilance amongst community pharmacists in Lagos state, south west Nigeria. Pharmacoepidemiol Drug Saf 2010 Sep 15. [Epub ahead of print].

Pharmacy World and ScienceBabar ZU, Stewart J, Reddy S, Alzaher W, Vareed P, Yacoub N, Dhroptee B, Rew A. An evaluation of consumers’ knowledge, perceptions and attitudes regarding generic medicines in Auckland. Pharm World Sci 2010; 32(4):440-448.

Pharmazie Weissenfeld J, Stock S, Lüngen M, Gerber A. The nocebo effect: a reason for patients’ non-adherence to generic substitution? Pharmazie 2010; 65(7):451-456.

PLoS Medicine Niens LM, Cameron A, Van de PE, Ewen M, Brouwer WB, Laing R. Quantifying the impoverishing effects of purchasing medicines: a cross-country comparison of the affordability of medicines in the developing world. PLoS Med 2010; 7(8) pii: e1000333.

PLoS Neglected Tropical Diseases Cavalli A, Bamba SI, Traore MN, Boelaert M, Coulibaly Y, Polman K, Pirard M, Van Dormael M. Interactions between Global Health Initiatives and country health systems: the case of a neglected tropical diseases control program in Mali. PLoS Negl Trop Dis 2010; 4(8):e798

Plos OneUdwadia ZF, Pinto LM, Uplekar MW. Tuberculosis management by private practitioners in Mumbai, India: has anything changed in two decades? PLoS ONE 2010; 5(8):e12023.

Population Health Management Nair KV, Miller K, Park J, Allen RR, Saseen JJ, Biddle V. Prescription co-pay reduction program for diabetic employees. Popul Health Manag 2010; 13(5):235-245.

Patel UB, Ni Q, Clayton C, Lam P, Parks J. An attempt to improve antipsychotic medication adherence by feedback of medication possession ratio scores to prescribers. Popul Health Manag 2010; 13(5):269-274.

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42INRUD News, January 2011

Psychiatric Services Robst JM, Constantine R, Boaz T, Andel R, Teague G, Becker M, Howe A. Short-term impact of preferred drug list changes on health care use and Medicaid costs: injectable risperidone. Psychiatr Serv 2010; 61(9):937-939.

Quality and Safety in Health CareWilczynski NL, Haynes RB. Optimal search filters for detecting quality improvement studies in Medline. Qual Saf Health Care 2010 Jul 29. [Epub ahead of print].

Research in Social and Administrative PharmacyGoedken AM, Urmie JM, Farris KB, Doucette WR. Impact of cost sharing on prescription drugs used by Medicare beneficiaries. Res Social Adm Pharm 2010; 6(2):100-109.

Revista de saúde pública Lopes LC, Barberato-Filho S, Costa AC, Osorio-de-Castro CG. Rational use of anticancer drugs and patient lawsuits in the state of Sao Paulo, Southeastern Brazil. Rev Saude Publica 2010; 44(4):620-628.

Revista panamericana de salud pública Madden JM, Meza E, Ewen M, Laing RO, Stephens P, Ross-Degnan D. Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology. Rev Panam Salud Publica 2010; 27(4):291-299.

Sexually Transmitted DiseasesCorbell C, Stergachis A, Ndowa F, Ndase P, Barnes L, Celum C. Genital ulcer disease treatment policies and access to acyclovir in eight sub-Saharan African countries. Sex Transm Dis 2010; 37(8):488-493.

Sexually Transmitted Infections Gomez GB, Campos PE, Buendia C, Carcamo CP, Garcia PJ, Segura P, Whittington WL, Hughes JP, Ward H, Garnett GP, Holmes KK.. Studying complex interactions among determinants of health care-seeking behaviours: self-medication for sexually transmitted infection symptoms in female sex workers. Sex Transm Infect 2010; 86(4):285-291.

Singapore Medical JournalShankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B. Drug utilisation among older inpatients in a teaching hospital in Western Nepal. Singapore Med J 2010; 51(1):28-34.

Social Science and MedicineKamat VR, Nyato DJ. Soft targets or partners in health? Retail pharmacies and their role in Tanzania’s malaria control program. Soc Sci Med 2010; 71(3):626-633.

Masiye F, Chitah BM, McIntyre D. From targeted exemptions to user fee abolition in health care: experience from rural Zambia. Soc Sci Med 2010; 71(4):743-750.

Surgery Kao LS, Lew DF, Doyle PD, Carrick MM, Jordan VS, Thomas EJ, Lally KP. A tale of 2 hospitals: a staggered cohort study of targeted interventions to improve compliance with antibiotic prophylaxis guidelines. Surgery 2010; 148(2):255-262.

Teaching and Learning in MedicineNaughton BJ, Singh R, Wisniewski AM, Singh G, Anderson DR. Improving quality of NSAID prescribing by internal medicine trainees with an educational intervention. Teach Learn Med 2010; 22(4):287-292.

TrialsEvans CD, Eurich DT, Taylor JG, Remillard AJ, Shevchuk YM, Blackburn DF. A pragmatic cluster randomized trial evaluating the impact of a community pharmacy intervention on statin adherence: rationale and design of the Community Pharmacy Assisting in Total Cardiovascular Health (CPATCH) study. Trials 2010; 11:76.

Brooker S, Okello G, Njagi K, Dubeck MM, Halliday KE, Inyega H, Jukes MC. Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya. Trials 2010; 11:93.

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43INRUD News, January 2011

Tobacco Control Smith MW, Chen S, Siroka AM, Hamlett-Berry K. Using policy to increase prescribing of smoking cessation medications in the VA health care system. Tob Control 2010 Sep 24. [Epub ahead of print].

Tropical Medicine and International HealthHasker E, Singh SP, Malaviya P, Singh RP, Shankar R, Boelaert M, Sundar S. Management of visceral leishmaniasis in rural primary health care services in Bihar, India. Trop Med Int Health 2010; 15 Suppl 2:55-62.

Bratt JH, Torpey K, Kabaso M, Gondwe Y. Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities. Trop Med Int Health 2010 Oct 19. [Epub ahead of print].

Harries AD, Zachariah R, Lawn SD, Rosen S. Strategies to improve patient retention on antiretroviral therapy in sub-Saharan Africa. Trop Med Int Health 2010; 15 Suppl 1:70-75.

Upsala Journal of Medical SciencesVægter K, Wahlström R, Wedel H, Svärdsudd K. Effect of mailed feedback on drug prescribing profiles in general practice: a seven-year longitudinal study in Storstrøm County, Denmark. Ups J Med Sci 2010.

Value in HealthChapman RH, Kowal SL, Cherry SB, Ferrufino CP, Roberts CS, Chen L. The modeled lifetime cost-effectiveness of published adherence-improving interventions for antihypertensive and lipid-lowering medications. Value Health 2010 Sep;13(6):685-94.

Chabot I, Rocchi A. How do cost-effectiveness analyses inform reimbursement decisions for oncology medicines in Canada? The example of sunitinib for first-line treatment of metastatic renal cell carcinoma. Value Health 2010 Sep;13(6):837-45.

Barron TI, Bennett K, Feely J. A competing risks prescription refill model of compliance and persistence. Value Health 2010 Sep;13(6):796-804.

Zeng F, An JJ, Scully R, Barrington C, Patel BV, Nichol MB. The impact of value-based benefit design on adherence to diabetes medications: a propensity score-weighted difference in difference evaluation. Value Health 2010 Sep;13(6):846-52.

Zhonghua Yi Xue Za Zhi Cao B, Sun LY, Liu K, Li RS, Liu YM, Tong ZH, Li WX, Pan SF, Yang Y, Huang KW, Li CS, Chen YY, Wang HY, Li B, Hu YS, Hou SC, Wang C. [A hospital-wide intervention program to optimize the utilization quality of carbapenems and glycopeptides]. Zhonghua Yi Xue Za Zhi 2009; 89(36):2557-2560.

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44INRUD News, January 2011

What is iNruD?The International Network for Rational Use of Drugs (INRUD) was established in 1989 with the goal of promoting the rational use of pharmaceuticals. INRUD’s strategy to achieve this includes—

• An interdisciplinary focus, linking clinical and social sciences

• Activities originating from country-based core groups of individuals representing ministries of health, universities, nongovernmental organizations, and private-sector institutions

• Belief in the importance of sharing relevant experiences and in technical cooperation among participating individuals

• Emphasis on understanding behavioral aspects of drug use, particularly the beliefs and motivations of providers and consumers

• Promotion of well-designed research studies to understand these behavioral factors, leading to reproducible interventions to improve drug use

• Development of useful tools for research, including standard research methodologies, simplified sampling and data collection strategies, and user-accessible computer software

Support for INRUD NewsThis newsletter was made possible through support provided by the Swedish International Development Cooperation Agency. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the Swedish International Development Cooperation Agency.

For further information about INRUD or INRUD News, please contact the INRUD Coordinator at the following address—

4301 North Fairfax Drive, Suite 400Arlington, Virginia 22203-1627 USATel: 703-524-6575Fax: 703-524-7898E-mail: inrud@msh.org

45INRUD News, January 2011

africa

Ethiopia: Tenaw AndualemP. O. Box 31540Addis Ababa, EthiopiaFax: +251-162-63-10E-mail: tenawandalem@hotmail.com ortandualem@msh.org

Ghana: Dr. David Ofori-AdjeiCentre for Tropical Clinical Pharmacology University of Ghana Medical SchoolP.O. Box 4236KorlebuAccra, GhanaE-mail: dofori@AfricaOnline.com.gh or Daniel Arhinful atdarhinful@noguchi.mimcom

Kenya: Prof. Bill LoreNairobiFax: +254-2-574108E-mail: kap@wananchi.com;lorebill@hotmail.com

Nigeria: Prof. Ambrose IsahUnit of Clinical Pharmacology and TherapeuticsDepartment of Medicine, University of BeninBenin City, NigeriaE-mail: ambroseisah@yahoo.com

Tanzania: Dr. Amos MasseleDept. of Clinical PharmacologyMuhimbili University CollegeFax: +255-51-151596E-mail: amassele@muchs.ac.tz

Uganda: Dr. Paul WaakoDept. of Pharmacology &TherapeuticsMakerere University Medical SchoolFax: +256-41-532-947E-mail: pwaako@med.mak.ac.ug

Zimbabwe: Dr. C. E. NdhlovuDirectorate of Pharmacy ServicesMinistry of Health and Child WelfareFax: +263-4-730-970 or +263-4-795-353E-mail: inrudzim@healthnet.zw

asia

Bangladesh: Prof. Azad ChowdhuryDept. of Clinical Pharmacy & PharmacologyUniversity of Dhaka Tel: +88-02-8625677 Cell No: +88-01713040361 E-mail: akchowdhury2003@yahoo.com,akazad@univdhaka.edu, or duregstr@bangla.net

Cambodia: Dr. Chroeng SokhanDept. of Drugs and FoodFax: +855-23-88 06 96E-Mail: sokhan@bigpond.com.kh

China: Dr. Zongjiu ZhangDept. of Health Policy andManagementPeking University School of Public HealthFax: +8610-82801607E-mail: fengwenmail@163.com;fengwenmail@sina.com

India/Delhi: Dr. Usha GuptaMaulana Azad Medical CollegeFax: +91-11-3235574E-mail: usha_gupta2@yahoo.com

India/Karnataka: Dr. Gopal DabadeDrug Action Forum – Karnataka57, Sony, Tejaswinagar, Dharwad 580002Karnataka, IndiaTel: +91(0)836-2461722Cell No: +91(0)9448862270Fax: +91(0)836-2461722E-mail: drdabade@gmail.com

India/Tamil Nadu: Dr. R. MuraliTamilNadu AIDS Control SocietyFax: +91-44-4983298E-mail: girijaa@md3.vsnl.net.in

Indonesia: Dr. Sri SuryawatiCentre for Clinical Pharmacologyand Drug Policy StudiesGadjah Mada UniversityFax: +62-274-563-596E-mail: suryawati@yogya.wasantara.net.id

Kyrgyzstan: Prof. Zurdinov AshiraliBishkekTel: +312-54-58-53, 54-58-92E-mail: zurdinov@mail.ru,a-zurdinov@yandex.ru

Nepal: Prof. Kumud K. KafleHead of Clinical PharmacologyTribhuvan UniversityTeaching HospitalFax: +977-1-4115515E-mail: inrud@healthnet.org.np

Philippines: Dr. Roberto A. RosadiaProgram Management Technical Advisors TeamFax: +632-742-8107E-mail: bobbyrosadia@cheerful.com

Thailand: Dr. Chitr Sitthi-amornDirector of Saint Louis HospitalBangkok, ThailandVia Ratana SomrongthongE-mail: schitr@chula.ac.th

Vietnam: Dr. Pham Huy DungVietnam Association of Family PhysiciansE-mail: dung@hn.vnn.vn

Europe

Karolinska Institutet: Dr. Göran TomsonDivision of International HealthDept. of Public Health SciencesStockholm, SwedenFax: +46-8-311-590E-mail: Goran.Tomson@phs.ki.se

Moldova: Dr. Natalia CebotarencoChisnauTel/Fax: +3732-2-4505-94E-mail: druginfomoldova@yahoo.com

World Health Organization: Dr. Kathy HollowayDepartment of Essential Medicines and Pharmaceutical PoliciesGeneva, SwitzerlandFax: +41-22-791-4167E-mail: hollowayk@who.int

Latin america

Peru: Dr. Raúl Cruzado UbillúsSeguro Integral de Salud–Ministerio de SaludFax: +51-1-387-9244E-mail: rcruzadou@usis.minsa.gob.pe

North america

WHO Collaborating Center in Pharmaceutical Policy and Drug Policy Research Group: Dr. Dennis Ross-DegnanDept. of Ambulatory Care &PreventionHarvard Medical SchoolBoston, MA, USAFax: +617-859-8112E-mail: drossdeg@hms.harvard.edu

INRUD Secretariat: Dr. John ChalkerManagement Sciences for HealthArlington, VA, USAFax: +703-524-7898E-mail: inrud@msh.org