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3D visualization as a communicative aid in pharmaceutical advice-giving over distance.

https://arctichealth.org/en/permalink/ahliterature132831
Source
J Med Internet Res. 2011;13(3):e50
Publication Type
Article
Date
2011
Author
Ostlund M
Dahlbäck N
Petersson GI
Author Affiliation
eHealth Institute, Linnaeus University, Kalmar, Sweden. martin.ostlund@lnu.se
Source
J Med Internet Res. 2011;13(3):e50
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Diabetes Mellitus, Type 2 - drug therapy
Drug Interactions
Drug-Related Side Effects and Adverse Reactions
Female
Health Services Research
Humans
Imaging, Three-Dimensional - methods
Male
Middle Aged
Patient Education as Topic - methods
Pharmaceutical Services - utilization
Program Evaluation
Remote Consultation - methods
Sweden
Telemedicine - methods
Young Adult
Abstract
Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information.
To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker.
We created a Web-based communication service called AssistancePlus that allows an advisor to demonstrate the physical handling of a complex pharmaceutical product to an advice seeker with the aid of 3D visualization and audio/video conferencing. AssistancePlus was tested in 2 separate user studies performed in a usability lab, under realistic settings and emulating a real usage situation. In the first study, 10 pharmacy students were assisted by 2 advisors from the Swedish National Co-operation of Pharmacies' call centre on the use of an asthma inhaler. The student-advisor interview sessions were filmed on video to qualitatively explore their experience of giving and receiving advice with the aid of 3D visualization. In the second study, 3 advisors from the same call centre instructed 23 participants recruited from the general public on the use of 2 products: (1) an insulin injection pen, and (2) a growth hormone injection syringe. First, participants received advice on one product in an audio-recorded telephone call and for the other product in a video-recorded AssistancePlus session (product order balanced). In conjunction with the AssistancePlus session, participants answered a questionnaire regarding accessibility, perceived expressiveness, and general usefulness of 3D visualization for advice-giving over distance compared with the telephone and were given a short interview focusing on their experience of the 3D features.
In both studies, participants found the AssistancePlus service helpful in providing clear and exact instructions. In the second study, directly comparing AssistancePlus and the telephone, AssistancePlus was judged positively for ease of communication (P = .001), personal contact (P = .001), explanatory power (P
Notes
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PubMed ID
21771714 View in PubMed
Less detail

Advent of mail-order pharmacy causes concern among some pharmacists.

https://arctichealth.org/en/permalink/ahliterature215208
Source
CMAJ. 1995 May 1;152(9):1485-6
Publication Type
Article
Date
May-1-1995
Author
D. Spurgeon
Source
CMAJ. 1995 May 1;152(9):1485-6
Date
May-1-1995
Language
English
Publication Type
Article
Keywords
Humans
Pharmaceutical Services - utilization
Pharmacies - utilization
Pharmacists
Postal Service
Professional-Patient Relations
Quebec
Societies, Pharmaceutical
Abstract
MEDITrust, a major mail-order pharmacy, promises low drug prices and dispensing fees for people who order drugs via mail. Its arrival has created some strong opposition in Quebec. The Canadian Pharmaceutical Association says the arrival of mail-order companies may give community pharmacists an opportunity to promote the benefits of face-to-face contact with pharmacists. The CMA's Dr. Anne Carter says there will always be a need for community pharmacists, who can provide drugs on short notice and provide personal counselling for patients.
PubMed ID
7728698 View in PubMed
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Clinical and economic consequences of a reimbursement restriction of nebulised respiratory therapy in adults: direct comparison of randomised and observational evaluations.

https://arctichealth.org/en/permalink/ahliterature181384
Source
BMJ. 2004 Mar 6;328(7439):560
Publication Type
Article
Date
Mar-6-2004
Author
Sebastian Schneeweiss
Malcolm Maclure
Bruce Carleton
Robert J Glynn
Jerry Avorn
Author Affiliation
Brigham and Women's Hospital and Harvard Medical School, Division of Pharmacoepidemiology and Pharmacoeconomics, 1620 Tremont St (Suite 3030), Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Source
BMJ. 2004 Mar 6;328(7439):560
Date
Mar-6-2004
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adolescent
Adult
Aged
British Columbia
Bronchodilator Agents - administration & dosage - economics
Cluster analysis
Cohort Studies
Cost Savings
Drug Costs - statistics & numerical data
Health Expenditures
Health Policy - economics
Humans
Insurance, Health, Reimbursement
Insurance, Pharmaceutical Services - utilization
Medical Assistance - utilization
Middle Aged
Abstract
To compare the results of a randomised and an observational evaluation of the same policy that restricted reimbursement for nebulised respiratory medications in adult patients in a community setting.
Cluster randomised controlled trial and observational time series with historical controls.
Pharmacare, the government funded drug benefits plan for elderly people and patients receiving social assistance in British Columbia, Canada.
In the randomised controlled trial 104 clusters of medical practices, pair matched by geography and approximately by practice size, were randomised to the intervention group (449 patients affected by the policy on 1 March 1999), and the control group (offered a six month exemption, affecting 386 patients). The observational analysis included all Pharmacare beneficiaries (excluding the 386 exempt patients) who had used any nebulised drugs six months before the policy (4624 patients).
Pharmacare restricted reimbursement for nebulised bronchodilators, steroids, and cromoglycate to patients whose doctors applied for an individual patient's exemption, giving an appropriate clinical reason.
Number of contacts with doctors and services, emergency admissions to hospital, and utilisation of and expenditure for respiratory drugs in databases of British Columbia's Ministry of Health.
Contacts with doctors or emergency admissions to hospital did not increase in association with the restriction, regardless of the analytical approach. In the observational analysis, we found a reduction of C24 dollars per patient month in all nebulised drug use (95% confidence interval 19 to 29) and an increase of C3 dollars per patient month in all expenditure for inhalers (1.4 to 4.5). The randomised evaluation found savings of C8 dollars per patient month for nebulisers (P = 0.24) and no increase in spending on inhalers (P = 0.79). Correcting for 60% non-compliance by exempt doctors in a sensitivity analysis yielded similar results as the observational evaluation.
Observational as well as randomised analyses found moderate net savings and no increase in unintended healthcare outcomes after restricting reimbursement for nebulised respiratory drugs. Randomised policy trials are feasible and, if carefully implemented, likely to be concordant with observational evaluations.
Notes
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PubMed ID
14982865 View in PubMed
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A comparison of general drug utilization in a metropolitan community with utilization under a drug prepayment plan.

https://arctichealth.org/en/permalink/ahliterature110449
Source
Am J Public Health Nations Health. 1968 Nov;58(11):2121-36
Publication Type
Article
Date
Nov-1968
Author
M R Greenlick
B J Darsky
Source
Am J Public Health Nations Health. 1968 Nov;58(11):2121-36
Date
Nov-1968
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Drug Prescriptions - utilization
Drug Therapy
Drug Utilization
Female
Financing, Personal
Health Expenditures
Humans
Infant
Insurance, Pharmaceutical Services - utilization
Male
Middle Aged
Ontario
Notes
Cites: Public Health Rep. 1966 Oct;81(10):938-404959415
Cites: J Health Hum Behav. 1963;4:14-2214015364
PubMed ID
4972373 View in PubMed
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Elderly women show neither a shortage of strategies nor an overreliance on drugs in handling aging and in dealing with minor health problems.

https://arctichealth.org/en/permalink/ahliterature174615
Source
J Women Aging. 2005;17(1-2):83-98
Publication Type
Article
Date
2005
Author
Philippe Voyer
Suzanne Laberge
Geneviève Rail
Author Affiliation
Faculty of Nursing, Laval University, Geriatric Research Group, Saint-Sacrement Hospital, Quebec, Canada. Philippe.Voyer@fsi.ulaval.ca
Source
J Women Aging. 2005;17(1-2):83-98
Date
2005
Language
English
Publication Type
Article
Keywords
Aged
Aging
Evaluation Studies as Topic
Female
Humans
Nonprescription Drugs - therapeutic use
Pharmaceutical Services - utilization
Poverty
Quebec
Abstract
Women 65 years old and over make up the fastest growing population segment in North America. They are, particularly among the underprivileged, known to be heavy consumers of prescribed and over-the-counter drugs. The objective of this study was to identify the role of medication in underprivileged elderly women's strategies for aging well and dealing with minor health problems. A qualitative study was conducted among 40 women aged 65 to 75. Results show that elderly women seldom mention resorting to medication to "age well" although they report using this strategy to deal with minor health problems. Overall, the elderly women mentioned a wide range of strategies to cope with aging and minor health problems, which suggests that they are well equipped to face the challenges of aging.
PubMed ID
15914421 View in PubMed
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The influence of prescription drug insurance on psychotropic and non-psychotropic drug utilization in Canada.

https://arctichealth.org/en/permalink/ahliterature161615
Source
Soc Sci Med. 2007 Dec;65(12):2553-65
Publication Type
Article
Date
Dec-2007
Author
Sisira Sarma
Kisalaya Basu
Anil Gupta
Author Affiliation
Microsimulation Modelling and Data Analysis Division, Applied Research and Analysis Directorate, Health Policy Branch, Health Canada, Ottawa, Ontario, Canada. sisita_sarma@hc-sc.gc.ca
Source
Soc Sci Med. 2007 Dec;65(12):2553-65
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Cross-Sectional Studies
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Female
Health status
Health Surveys
Humans
Insurance, Pharmaceutical Services - utilization
Male
Middle Aged
Models, Econometric
Models, Statistical
National Health Programs - utilization
Psychotropic Drugs - therapeutic use
Socioeconomic Factors
Stochastic Processes
Utilization Review - statistics & numerical data
Abstract
Using 2002 Canadian Community Health Survey data, this paper examines the effect of public and private prescription drug insurance on the utilization of psychotropic and non-psychotropic drugs. It is found that prescription drug utilization is characterized by two stochastic regimes requiring use of latent class modelling framework. In many instances, results differ for the classes of high and low users of prescription drugs. After accounting for the unobserved individual heterogeneity and a number of socio-demographic factors, health status, and province fixed effects, we find that having prescription drug insurance (public or private) increases the expected number of non-psychotropic medications for both low and high users. Public insurance affects psychotropic drug utilization positively for the low-user group only. The statistical insignificance of insurance for the high-user psychotropic drugs or lower magnitude of insurance coefficients on high-user non-psychotropic drugs seems to stem from high inelastic demand for prescription drugs in the concerned groups. In addition, we find that age, self-reported health status, and long-term mental and physical health problem diagnosed by a health professional are important determinants of prescription drug utilization for both classes of users.
PubMed ID
17761377 View in PubMed
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Pharmacy provision of emergency contraception: the Ontario emergency contraception pilot project.

https://arctichealth.org/en/permalink/ahliterature182922
Source
J Obstet Gynaecol Can. 2003 Nov;25(11):923-30
Publication Type
Article
Date
Nov-2003
Author
Sheila Dunn
Thomas E R Brown
Marsha M Cohen
Rhonda Cockerill
Kris Wichman
Nancy Weir
Anna Pancham
Author Affiliation
Regional Women's Health Centre, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada.
Source
J Obstet Gynaecol Can. 2003 Nov;25(11):923-30
Date
Nov-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Contraceptives, Oral - administration & dosage
Contraceptives, Postcoital - administration & dosage
Emergency Treatment
Female
Health Services Accessibility
Humans
Middle Aged
Ontario
Pharmaceutical Services - utilization
Pilot Projects
Pregnancy - drug effects
Time Factors
Abstract
To develop and evaluate a program to provide emergency contraception (EC) directly in pharmacies that would recruit and train pharmacists and physician partners, and inform women about the availability of EC in pharmacies.
Pharmacists and physicians working in the Scarborough, Rexdale, and North York regions of Toronto were recruited to receive a training program on EC. The pharmacists in each pharmacy were linked with a designated physician who retrospectively authorized prescriptions provided under the protocol. Client eligibility for EC was determined using a self-administered questionnaire that was reviewed by the pharmacist. A poster and radio campaign advertised the service, and a telephone hotline informed users of their nearest participating pharmacy. Data on the client's age, reasons for requesting EC, time elapsed from intercourse until presentation, and requests for follow-up referral were analyzed using descriptive methodology. User satisfaction was determined through a mail-back questionnaire.
A total of 146 pharmacists practising in 40 pharmacies were linked with 34 physicians. In the 1 year of the project, 6931 prescriptions for EC were provided. Fifty-four percent of the women accessed EC within 24 hours of intercourse. The majority of women were very satisfied with the service, and 21.1% indicated that had they not obtained EC in this way, they would not have obtained it elsewhere. More information about birth control was desired by 10.2% of the women.
Direct pharmacist provision of EC is an effective pregnancy-prevention strategy that is well accepted by the women who access it.
PubMed ID
14608442 View in PubMed
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Prescription drug benefits and Canada's uninsured.

https://arctichealth.org/en/permalink/ahliterature173173
Source
Int J Law Psychiatry. 2005 Sep-Oct;28(5):496-513
Publication Type
Article
Author
Carolyn S Dewa
Jeffrey S Hoch
Leah Steele
Author Affiliation
Centre for Addiction and Mental Health, Health Systems Research and Consulting Unit, 250 College St, Toronto, Ontario, and University of Toronto, Department of Psychiatry, Canada. carolyn_dewa@camh.net
Source
Int J Law Psychiatry. 2005 Sep-Oct;28(5):496-513
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Cross-Sectional Studies
Data Collection
Female
Humans
Insurance, Pharmaceutical Services - utilization
Male
Medically Uninsured
Mental disorders
Middle Aged
National Health Programs - legislation & jurisprudence
Psychotropic Drugs
Universal Coverage
Abstract
The Canada Health Act provides a framework for the Canadian health system and a mechanism for federal healthcare funds to flow to the provinces. Presently, the Canada Health Act covers medically necessary hospital, physician and surgical-dental as well as limited long-term care services, but not prescription medication. Though not mandated, each province has chosen to also develop a prescription drug benefit plan. These plans differ with respect to the groups that are covered and the type of coverage provided. In this paper, we describe the key structural elements of the various provincial plans. In addition, using a population-based national health and mental healthcare survey of 33,000 Canadians, we explore the characteristics of the population currently not covered by prescription drug benefits. Finally, we look at a sub-population of Canadians with mental illness with regard to their insurance coverage and use of prescription drugs. Our findings suggest that drug coverage within provinces is working for individuals with chronic physical conditions only. The findings herein reaffirm the need for a national strategy, support the notion that prescription drug coverage is important, and raise questions about the role of employers in providing these benefits.
PubMed ID
16125777 View in PubMed
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Registration for public drug benefits across areas of differing ethnic composition in British Columbia, Canada.

https://arctichealth.org/en/permalink/ahliterature142709
Source
BMC Health Serv Res. 2010;10:171
Publication Type
Article
Date
2010
Author
Vivian W Leong
Steve Morgan
Sabrina T Wong
Gillian E Hanley
Charlyn Black
Author Affiliation
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada. viv.leong@gmail.com
Source
BMC Health Serv Res. 2010;10:171
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
British Columbia
Databases, Factual
Ethnic Groups
Female
Humans
Insurance, Pharmaceutical Services - utilization
Logistic Models
Male
National Health Programs
Public Sector
Social Class
Abstract
In 2003, the government of British Columbia, Canada introduced a universal drug benefit plan to cover drug costs that are high relative to household income. Residents were required to register in order to be eligible for the income-based benefits. Given past research suggesting that registration processes may pose an access barrier to certain subpopulations, we aimed to determine whether registration rates varied across small geographic areas that differed in ethnic composition.
Using linked population-based administrative databases and census data, we conducted multivariate logistic regression analyses to determine whether the probability of registration for the public drug plan varied across areas of differing ethnic composition, controlling for household-level predisposing, enabling and needs factors.
The adjusted odds of registration did not differ across regions characterized by high concentrations (greater than 30%) of residents identifying as North American, British, French or other European. Households located in areas with concentrations of residents identifying as an Asian ethnicity had the highest odds of program registration: Chinese (OR = 1.21, CI: 1.19-1.23) and South Asian (OR = 1.19, CI: 1.16-1.22). Despite this positive finding, households residing in areas with relatively high concentrations of recent immigrants had slightly lower adjusted odds of registering for the program (OR = 0.97, CI: 0.95-0.98).
This study identified ethnic variation in registration for a new public drug benefit program in British Columbia. However, unlike previous studies, the variation observed did not indicate that areas with high concentrations of certain ethnicities experienced disadvantages. Potential explanations are discussed.
Notes
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PubMed ID
20565754 View in PubMed
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Restrictive access to clopidogrel and mortality following coronary stent implantation.

https://arctichealth.org/en/permalink/ahliterature158857
Source
CMAJ. 2008 Feb 12;178(4):413-20
Publication Type
Article
Date
Feb-12-2008
Author
Odile Sheehy
Jacques LeLorier
Stéphane Rinfret
Author Affiliation
Pharmaco-economics and pharmaco-epidemiology unit, Centre Hospitalier de l'Université de Montréal Research Centre, Université de Montréal, Montréal, Que.
Source
CMAJ. 2008 Feb 12;178(4):413-20
Date
Feb-12-2008
Language
English
Publication Type
Article
Keywords
Aged
Canada - epidemiology
Cause of Death - trends
Coronary Artery Bypass - instrumentation
Coronary Artery Disease - mortality - surgery
Coronary Restenosis - drug therapy - mortality
Drug Costs
Drug Prescriptions - economics
Female
Follow-Up Studies
Humans
Insurance, Pharmaceutical Services - utilization
Male
Middle Aged
Multivariate Analysis
Platelet Aggregation Inhibitors - economics - therapeutic use
Retrospective Studies
Stents
Survival Rate - trends
Ticlopidine - analogs & derivatives - economics - therapeutic use
Time Factors
Abstract
In Canada, access to clopidogrel is restricted by most provincial drug insurance plans in order to contain costs. Until April 2007, the Régie de l'assurance maladie du Québec (RAMQ) Prescription Drug Insurance Plan reviewed special access forms before approving reimbursement for clopidogrel prescriptions. We investigated the impact of this restrictive process on patient's filling of prescriptions and on all-cause mortality following coronary stenting.
We analyzed prescriptions filled and all-cause mortality in the year following a percutaneous coronary intervention among patients who underwent stent implantation between January 2000 and September 2004. We obtained administrative data from the RAMQ databases. We included patients who filled at least 1 prescription for a nonrestricted cardiovascular drug after hospital discharge. We used Cox proportional models to compare mortality rates as a function of delayed or absent outpatient clopidogrel therapy.
Of 13,663 patients, 1571 (11.5%) did not fill any clopidogrel prescription despite filling at least 1 nonrestricted cardiovascular drug prescription after a percutaneous coronary intervention, and 1174 (8.6%) patients filled their clopidogrel prescription with a delay of at least 1 day (median delay 5 days) after filling the nonrestricted cardiovascular drug prescription. After controlling for pertinent covariables, not filling a clopidogrel prescription (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.35-2.15) and filling with a delay (HR 1.34, 95% CI 1.01-1.80) were associated with a significant increase in all-cause mortality.
Restricted access to clopidogrel was associated with about 20% of patients either not receiving clopidogrel or receiving therapy after a delay. Delay or absence of clopidogrel therapy increased the risk of all-cause mortality after percutaneous coronary intervention with stenting.
Notes
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PubMed ID
18268267 View in PubMed
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11 records – page 1 of 2.