The journal of medicine access最新文献

Background: Substandard and falsified (SF) medical products are removed from circulation through a process called 'product recall' by medicines regulatory agencies. In Zambia, the Zambia Medicines Regulatory Authority (ZAMRA) is responsible for recalling SF medical products from the Zambian market through passive and active surveillance methods. This study aimed to describe the prevalence of recalls of SF medical products and to analyse the frequently recalled therapeutic categories, dosage forms, categories of defects that led to the recalls and their sources with respect to the country of the marketing authorisation holder (MAH) or manufacturer.

Methods: We conducted a descriptive cross-sectional review of the product recalls issued by ZAMRA between January 2018 and December 2021. A search for all medical product alerts and recalls issued by ZAMRA was carried out by reviewing the internal post-marketing surveillance database kept at ZAMRA headquarters. Data were extracted using a structured Excel database and analysed using Microsoft Excel.

Results: A total of 119 alerts were received during the review period, of which 83 (69.7%) were product recalls. Oral solid dosage forms were the most recalled dosage form (53%). Furthermore, the number of recalls increased in 2020 (44.6%) and 2021 (22.9%), with the majority (20.5%) of the recalled products being substandard products classified as antiseptics and disinfectants and were attributed to the high demand during the COVID-19 pandemic. Manufacturing laboratory control issues were the reason for product recall in almost half (47.4%) of the cases. Most of the products recalled originated from India (38.6%), followed by Zambia (25.3%). Only one suspected falsified product was recalled between 2018 and 2021. A total of 66 recalls of the 83 products were initiated by ZAMRA, with only 17 voluntarily by foreign MAHs. No product recall was initiated by the local representatives of foreign manufacturers or MAH.

Conclusion: The majority of the pharmaceutical product recalls in Zambia were substandard products. Manufacturing laboratory control issues lead to most recalls and require investigation of the root causes, preventive action, and strict compliance with the good manufacturing practices guidelines by manufacturers.

Prior to the outbreak of the COVID pandemic, pharmaceutical shortages were already recognised as a major policy problem by most, if not all, European governments; and virtually all European national governments today publicise official shortage lists. Policy making in the area has been centred on the national government level, which meant that the understanding, definition, and response to shortages has remained highly heterogeneous. When the advent of the COVID pandemic exacerbated shortages, this situation continued against a background of a weak collective European response. As part of their responses to COVID-shortages, the medicines regulators of European countries expanded the range of products pharmacies could manufacture, process and distribute as well as their procedural authority in issuing, handling and processing prescriptions. While these measures were fairly common across Europe and alleviated some bottlenecks or improved medicine access for some patient groups, other responses were highly individualistic and included export bans of certain medications as well as efforts to draw on veterinary supplies. Our own data analysis of officially recorded shortage data during the first COVID wave (to October 2020) indicates that countries that had prepared for these types of crisis and maintained an active policy stance (e.g. Germany and Norway) were more likely to encounter fewer shortages than others. We also note that there is no direct correlation between officially recorded numbers of shortages and the ways in which national governments responded to these - which indicates that cultural expectations also might have been a significant policy driver.

It is reported that at least one medication error per day occurs in hospitalized patients. Medication errors are not only harmful but also expensive. Prescription review by pharmacists is the standard to reduce prescribing error; however, due to the manual process, pharmacists lack time to conduct prescription reviews. Computerized physician order entry (CPOE) allows clinicians to directly place medication orders electronically, transmitted directly to the pharmacy. Successfully implemented CPOE systems improve the prescribing process and result in fewer medication errors. However, regardless of its significance, implementation of CPOE is a very difficult task, particularly in a public-sector hospital. Lady Reading Hospital-Medical Teaching Institution has a manual system for indenting medication system; pharmacists could only ensure the current dispensing of medication, but lack time and information to conduct a review to ensure the appropriateness of prescription. The article entails the barriers and the process of implementation of e-prescribing.

Background: A high rate of unintended pregnancy is said to be driving population growth, particularly in Sub-Saharan Africa, where approximately half of all pregnancies are unintended, coming too soon or even unwanted. Most of these unintended pregnancies could have been prevented with effective family planning services. There, however, remains an unmet gap between the women's reproductive intention and their contraceptive behaviour.

Objectives: This study determined the prevalence of unmet needs for family planning and examined its determinants among women of reproductive age group at a tertiary health facility in Southwest Nigeria.

Design: This was a hospital-based cross-sectional study.

Methods: Two hundred eighty-five sexually active women were recruited using a pre-tested, semi-structured, validated, interviewer-administered questionnaire. The questionnaire assessed the respondent's socio-demographic characteristics, obstetrics and gynaecological history, and contraceptive history. Relevant clinical parameters were measured and recorded. Data were analysed using SPSS version 21. Multivariable logistic regression analysis was done using a 5% significance level to identify the determinants of unmet needs for family planning.

Results: The prevalence of unmet family planning needs for prevention, spacing and limiting were 28.8%, 33.1% and 38.1%, respectively, with 58.2% overall prevalence of unmet needs. The commonest reason for the non-uptake of contraceptives among those with unmet need was the fear of side effects (66.3%). The odds of having unmet needs for family planning were higher for respondents with four or fewer children (adjusted odds ratio (AOR): 7.731; 95% confidence interval (CI): 28.504-2.907, p = 0.002) and those with one partner (AOR: 2.008; 95% CI: 3.669-1.090, p = 0.025).

Conclusion: A high rate of unmet family planning needs was found in the study. This requires specific interventions and policies towards increasing contraceptive uptake, such as intensified health education aimed at allaying fears related to the side effects.

Introduction: Anticholinergic medications which are commonly prescribed to older adults can produce more pronounced adverse effects compared to the younger population.

Objectives: To investigate the prevalence of polypharmacy, describe the prescription patterns of anticholinergic medications, determine the prevalence of exposure to high-risk anticholinergic cognitive burden (ACB) medications, and identify the potential predictors of exposure to high-risk ACB medications in older adults in a Nigerian secondary hospital.

Methods: This cross-sectional study that included older adults prescribed at least one anticholinergic medication was conducted at a secondary care hospital in Nigeria. The study data were initially summarized using descriptive statistics, whereas multivariable logistic regression analysis was used to identify the potential predictors of exposure to high-risk ACB medications. In this study, the cumulative ACB scores were dichotomized into low risk (score 1-2) and high risk (score ⩾ 3). A p value less than 0.05 was considered to be statistically significant.

Results: A total of 256 older adults were included in this study; 113 (44.1%) had polypharmacy, whereas 26.6% (188/256) were exposed to high-risk ACB medications. Of a total of 391 anticholinergic medications used by the population, furosemide (36.57%) was the most commonly prescribed. The adjusted multivariable logistic regression analysis indicated that patients who had acute diseases were 2.5 times (adjusted odds ratio (AOR) = 2.49, 95% confidence interval (CI): 1.40-4.45) more likely to be exposed to high-risk ACB medications than those with chronic diseases.

Conclusion: The study demonstrates a high prevalence of polypharmacy and exposure to high-risk ACB medications suggesting the need for pharmaceutical care in this high-risk population. Older adults' exposure to high-risk ACB medications was significantly associated with prescriptions for acute diseases.

Background: In Canada, healthcare professionals often rely on ad hoc interpreters, who are untrained volunteers recruited via intercom hospital announcements to interpret for patients with language barriers. This study analyzed the frequency of ad hoc interpreter requests via intercom announcements to estimate hospital interpretation needs.

Methods: A retrospective cohort analysis from intercom requests for medical interpretation collected from five hospitals of the McGill University Health Center. Requests included date, time, language requested, hospital location, and extension for who placed the request.

Results: A total of 1265 intercom requests were placed for 48 languages, with the top five languages being Mandarin (17.8%), Punjabi (10.1%), Inuktitut (9.8%), Arabic (7.3%), and Cantonese (6.4%). Almost 69.8% of requests were made during working hours, 13.2% on workday evenings, and 14.8% on weekends. Requests came from urgent care (42.3%), outpatient (29.5%), and inpatient (23.3%) settings.

Conclusion: This is the first published study that measures interpretation needs via intercom requests. We propose that our method can be replicated to inform implementation of professional medical interpretation services. We conclude that linguistic interpretation needs are significant in the Montreal area, and likely in Canada in general and pose a barrier to effective medical care.

Information about where medicines are in stock and how much they cost facilitates consumers' timely access to affordable medicines by enabling price comparisons and the identification of stockists. Our aims were to: (1) Review how consumer access to price and availability information is engaged within the Medicine Access discourse and (2) identify factors associated with the existence of interventions that provide consumers with medicine availability and price information. We conducted two scoping reviews. We reviewed 26 medicine access and pharmaceutical system strengthening frameworks to assess how they conceptualise information access. We then reviewed four interventions that provide consumers with availability and price information to identify the factors associated with these interventions' existence. We found that in the medical access discourse, information is mainly cast as helpful to entities that ensure medicine access for populations. Information as an enabler of medicine procurement for consumers/households is less emphasised. We then identified the following eight factors that facilitate consumer access to reliable medicine price and availability information: the recognition of a medicine access problem that can be mitigated by consumer access to information; cross-sectoral collaboration; the willingness of medicine sellers to disclose their inventory information; having information quality control measures; appropriate incentives for intervention adoption; enabling legal environments; systems of pooling information; and access to digital information technology infrastructure. We recommend that more theoretical and implementation attention ought to be directed at how medicine price and medicine availability information can empower individual consumers to make sound purchasing decisions.

Background: Globally, one of the most common causes of irrational use of medicines is brand-name prescribing. The consequence of prescribing medicines using brand names is an economic burden on patients and society. Thus, this study aimed to investigate the magnitude of prescribing medicines by brand names in a tertiary hospital in Mwanza, Tanzania.

Methods: A retrospective cross-sectional study was conducted between April 2020 and March 2021 at the Bugando Medical Centre. Data were collected from electronic prescriptions (outpatients) and medical files (inpatients). The data were analyzed using STATA version 14. A Chi-square test was conducted to examine the relationship between different categorical variables. p-Values of less than 0.05 were considered statistically significant.

Results: Of 851 prescriptions analyzed, 416 (48.9%) contained medicines prescribed using brand names. Compared to outpatient units, the proportion of prescriptions with medicines prescribed by brand names in inpatient units was significantly higher (58.5% vs 39.1%), p < 0.001. The most frequently prescribed medicines by brand names were Ampiclox (ampicillin + cloxacillin), 35.2%, Buscopan (hyoscine butylbromide), 8.7%, and Amoxyclav (amoxicillin + clavulanic acid), 7.7%.

Conclusion: Prescriptions written with brand names were found to be common, especially among fixed-dose combinations (FDCs), according to the current study. Governments, institutions, and other stakeholders should support and encourage the use of generic names in prescription writing because it saves money for patients and health care systems. This calls for Tanzania's government to prioritize the development and implementation of generic prescribing policies.

Background: In Germany, the number of calls for Emergency Medical Services (EMS) are increasing, while the number of general practitioners and hospitals are decreasing, resulting in a growing demand and workload for emergency physicians and paramedics. Furthermore, an aging population with increasingly complex medical histories, present emergencies in which a more detailed assessment and therapies are urgently needed. Therefore, common EMS systems need to find solutions to handle these problems.

Methods: We used a user-focused five-step approach to define a technological solution: Research of current systems, definition of goals and requirements, development of concept, test series and evaluation, evaluation of costs and benefits.

Results: Development of a holistic telemedical concept to connect in-hospital clinical emergency physicians and paramedics on the scene, by implementing and connecting systems that are already partially being used in common EMS in Germany. By using live audio and video communication, including vital signs between the two, a system can be established by keeping costs low, affordable and at the same time protecting patient data in line with General Data Protection Regulation.

Conclusion: Implementing technologies in a practical specialty like Emergency Medicine with a user-focused approach demonstrates that the hurdle for integration into established routines can improve current processes. Evaluation of costs and usability is a main driver to define success of such concepts and can improve if such systems can be developed to be used in larger networks.