Karolina Andersson

A comparative analysis of remuneration models for pharmaceutical professional services

OBJECTIVES Pharmacists provide a wide range of professional services to support the appropriate use of medicines by patients. This study aims to conduct an international, comparative analysis of remuneration models for pharmaceutical professional services. METHODS Information about remuneration models was derived from a literature review and a semi-structured questionnaire completed by experts. RESULTS Remuneration models differ in the way that pharmacists are paid for professional services beyond dispensing medicines. Also, the scope of services that are remunerated varies. The majority of countries regulate remuneration for services only when the medicine is paid for under the reimbursement scheme. Remuneration of services implies a commitment to assure their quality in some countries. Collaborative practice models have been set up where pharmacists work together with other health care professionals to deliver diagnosis-specific services or services based on the patients use of medicines. The remuneration of services is influenced by the value of services, budgetary constraints, the payer perspective, and the attitude of physicians, pharmacists and patients. CONCLUSIONS Professional organisations need to formulate a clear strategy for developing and gaining remuneration for pharmaceutical professional services. This implies that pharmacists not only demonstrate the value of services, but also assure their quality.

Socioeconomic determinants of psychotropic drug utilisation among elderly: a national population-based cross-sectional study

BackgroundPsychotropic drugs are commonly utilised among the elderly. This study aimed to analyse whether two socioeconomic determinants - income and marital status - are associated with differences in utilisation of psychotropic drugs and potentially inappropriate psychotropic drugs among elderly in Sweden.MethodsAll individuals aged 75 years and older who had purchased a psychotropic drug in Sweden during 2006 were included (68.7% women, n = 384712). Data was collected from national individual-based registers. Outcome measures were utilisation of three or more psychotropic drugs and utilisation of potentially inappropriate psychotropic drugs, as classified by the Swedish National Board of Health and Welfare.ResultsIndividuals with low income were more likely to utilise three or more psychotropic drugs compared to those with high income; adjusted odds ratio (aOR) 1.12 (95% confidence interval [CI] 1.10-1.14). The non-married had a higher probability for utilising three or more psychotropic drugs compared to the married (aOR 1.22; CI 1.20-1.25). The highest probability was observed among the divorced and the never married. Potentially inappropriate psychotropic drugs were more common among individuals with low compared to high income (aOR 1.14; CI 1.13-1.16). Compared to the married, potentially inappropriate psychotropic drug utilisation occurred more commonly among the non-married (aOR 1.08; CI 1.06-1.10). The never married and the divorced had the highest probability.ConclusionsThere was an association between socioeconomic determinants and psychotropic drug utilisation. The probability for utilising potentially inappropriate psychotropics was higher among individuals with low income and among the non-married.

Physicians' opinions and experiences of the Pharmaceutical Benefits Reform

Aim: To investigate opinions on and experiences of the new Pharmaceutical Benefits Reform (PBR) among physicians working in the Swedish county council of Region Västra Götaland. Methods: Questionnaires were sent to all private practitioners who had contracts with the county council of Region Västra Götaland (n=320) and a random sample of 25% of the doctors employed by the same county council (n=1,068). The questionnaire comprised questions on how the physicians had received information on the PBR and sought opinions on the introduction of generic substitution in pharmacies, workplace codes, individual prescriber codes, and the Pharmaceutical Benefits Board. Analyses were performed with logistic regression. Results: The response rate was 65%. The majority of doctors had received sufficient information about the reform, most often from their employer, followed by the Drug and Therapeutics Committees. More than half of the respondents were positive about the introduction of generic substitution, which was associated with the respondents age, experiences, and employer. Most of the doctors thought that generic substitution could reduce the health systems pharmaceutical expenditure, which was associated with the employer. One-third reported that generic substitution had caused problems for their patients in the past month. The probability of being mainly positive towards the newly created Pharmaceutical Benefits Board, which decides on reimbursement, increased with increasing age. Conclusions: Most participating doctors had received sufficient information about the reform and thought that generic substitution could save money for society. Age, employer, and experiences appeared to influence opinions on several issues.

Prescribing behaviour after the introduction of decentralized drug budgets: Is there an association with employer and type of care facility?

Objective. To analyse whether prescribing patterns changed after introduction of drug budgets and whether there is an association between drug prescribing patterns and the type of employer and care facility. Methods. Data analysed encompassed information on dispensed medicines, by workplaces, prescribed in the Region Västra Götaland, Sweden, for the years 2003 and 2006. Workplaces (n = 969) were categorized according to type of employer and type of care facility. Five prescribing indicators reflecting goals for cost-containing prescribing in Region Västra Götaland were assessed. Changes over time and differences between different types of employer and care facility were analysed by Mann–Whitney tests. Results. In 2003, workplaces with a public employer had a significantly higher adherence to three of the prescribing indicators compared with private practitioners. Two of these differences remained in 2006. In 2003, none of the prescribing indicators differed between primary care and other care facilities. Three years later workplaces in primary care had a significantly higher adherence to three of the prescribing indicators than other care facilities. There was a statistically significant difference in change between 2003 and 2006 between primary care and other care facilities; there were no differences in change between workplaces with public and private employers. Conclusions. Adherence to three of the prescribing indicators increased after the introduction of decentralized drug budgets. Workplaces with a public employer showed greater adherence to two of the prescribing indicators than private sector workplaces.

Prognostic value of the quality indicator “concurrent use of three or more psychotropic drugs” among residents of long-term care facilities: a comment

To the Editor: We welcome the highly relevant research by Bell et al. [1] showing that the indicator “concurrent use of three or more psychotropic drugs” does not predict 5-year all-cause mortality among residents of long-term care facilities. To our knowledge, this research is the first to investigate health outcomes associated with this indicator. Validation of the indicator’s clinical relevance is clearly warranted and a current topic, partly as it is used in national assessments of quality and efficiency in the healthcare system [2]. Bell et al. assessed drug exposure during a 2-week period. A repeated exposure assessment would perhaps be preferred over this cross-sectional measurement in relation to the outcome of 5-year all-cause mortality. The exclusion of drugs prescribed “when needed” can be problematic, as some of these drugs still may be used on a relatively continuous basis among the elderly. Nevertheless, the results emphasize the lack of evidence to support the use of the indicator “concurrent use of three or more psychotropic drugs” in quality assessments. Further, as Bell et al. acknowledge, the prognostic value of the indicator may vary depending on characteristics of the study population and how drug use is monitored. The findings by Bell et al. complement our previous research in which we assessed the extent to which the indicator captured use of potentially inappropriate psychotropic drugs (PIP) among the elderly [3]. We found that only one quarter of those using PIP had the indicator and concluded that clinical relevance should be balanced against convenience of use when selecting instruments to assess appropriateness in drug therapy in the elderly. Therefore, a further comparison also encompassing PIP in relation to mortality would be of high interest and value and add a new dimension in the validation process. Previous research has shown that a large number of drugs is a strong predictor for use of potentially inappropriate drugs [4]. We found that 72% of individuals with the indicator used PIP [3]. Thus, if a scan for specific drugs or combinations is unfeasible in quality assessments, the indicator may serve as a crude screening tool for inappropriate drug use. However, based on the findings by Bell et al., together with our previous findings, we strongly advocate the use of thoroughly validated and clinically relevant measurements in quality assessments. Conclusively, we agree with Bell et al. when they stress the compelling need for research on health outcomes associated with measurements of quality in drug use among the elderly and further call for careful consideration regarding the choice of measurements in quality assessments.