Louise E. Curley

A review of DTCA techniques: Appraising their success and potential impact on medication users

Background: Direct‐to‐consumer advertising (DTCA) has been present in some countries for nearly two decades. Its success and ramifications have been examined but not yet cataloged recently in a comprehensive manner. Objective: To review existing literature studies on the topic of DTCA techniques to provide an analysis of the current methods considered by drug marketers to enhance the effect of pharmaceutical product promotion and its success, as well as examine ramifications on the drug use process. Methods: A search of 7 electronic databases including MEDLINE and SCOPUS was conducted in December 2015, and updated until February 2016. A scientific review of literature (2008–2015) was performed to identify and collate information from relevant, peer reviewed original study articles investigating various DTCA techniques commonly employed in pharmaceutical promotion. A thematic analysis was undertaken to categorize categories of drug promotion, or techniques, and the saliency and impact of these. Results: Nineteen original study articles were included in this review. All articles were based in the U.S. and New Zealand, where DTCA is legal. After reviewing all the articles, 4 themes with 11 subcategories were generated. These themes included disease mongering and medicalization, drug references, advertisement strategies and eDTCA. The themes describe different categories of techniques used to augment DTC advertisements to increase their impact and overall success in promoting a pharmaceutical product. Many DTCA techniques utilized by pharmaceutical marketers are beneficial to the success of DTC promotion of a drug. These techniques include the use of drug efficacy information, comparative claims, non‐branded help seeking advertisements, formatted risks information, celebrity or expert endorsers and website trust factors. Through their use, public perception of the drug is made more favorable, increased attention is drawn to the advertisement, and the pharmaceutical product gains greater credibility and subsequent success in sales. However some techniques, although beneficial to pharmaceutical promotion, need to be monitored by policymakers and regulatory advisors, as they have the potential to negatively impact consumer health knowledge. Conclusion: Overall, through this review it is evident that there are a number if techniques that employed by pharmaceutical marketers to augment the success of pharmaceutical promotion. While these techniques may be beneficial to pharmaceutical companies and might increase awareness amongst consumers, it is important to be critical of them, as they have the potential to be exploited by pharmaceutical marketers. This review indicated that although some techniques are successful and appear to be satisfactory in providing information to consumers, other techniques need to be appraised more closely.

Randomized controlled trials covering pharmaceutical care and medicines management: A systematic review of literature

Objective To review the effects of pharmaceutical care on hospitalizations, mortality and clinical outcomes in patients. Methods Systematic searches were conducted in MEDLINE, EMBASE and International Pharmaceutical Abstracts (IPA) databases to identify studies that were published between 2004 and January 2017. Studies included in this review were randomized controlled trials (RCTs) that spanned across both community and hospital settings. Using strict inclusion/exclusion criteria studies were included if they reported level 1 or 2 outcomes in the hierarchy of outcome measure i.e. clinical and surrogate outcomes (e.g. blood pressure (BP) control, blood glucose level, cholesterol BMI). Each study was assessed for quality using the Jadad scoring system. Results Fifty‐four RCTs were included in the present review. Forty‐six of these studies ranked high quality according to the Jadad scoring system. Studies were categorized into their general condition groups. Interventions in patients with diabetes, depression, respiratory disorders, cardiovascular disorders, epilepsy, osteoporosis, and interventions in older adults were identified. In the majority of studies pharmaceutical care was found to lead to significant improvements in clinical outcomes and/or hospitalizations when compared to the non‐intervention group. Some conditions had a large number of RCTs, for example for cardiovascular conditions and in diabetes. Statistically significant improvements were seen in the majority of the studies included for both of these conditions, with studies indicating positive clinical outcomes and/or hospitalizations rates. Within the cardiovascular condition, a subset of studies, focusing on cardiac heart failure and coronary heart disease, had more mixed results. In other conditions the number of RCTs conducted was small and the evidence did not show improvements after pharmaceutical care, i.e. in depression, osteoporosis, and epilepsy. The majority of interventions were face to face interactions with patients, whilst a smaller number were conducted via the telephone and one via a web‐based system. Patient education was a key component of most interventions, either verbal and/or written. Longitudinal data, post intervention cessation, was not collected in the majority of cases. Conclusions RCTs conducted to evaluate pharmaceutical care appear to be effective in improving patient short‐term outcomes for a number of conditions including diabetes and cardiovascular conditions, however, other conditions such as depression are less well researched. Future research should attempt to evaluate the conditions where there is a lack of data, whether the positive effects of pharmaceutical care persist in patient populations after the interventions cease and what the long‐term clinical outcomes would be of continued pharmaceutical care.

Pharmaceutical Policy in Pakistan

Pakistan is a lower middle-income country, and healthcare in the country is regulated by the Ministry of National Health Services Regulation and Coordination. The overall poor performance in health care is reflected in the form of enormous burden of communicable and non-communicable diseases, and high maternal, neonatal and infant mortality rates. These issues are coupled with a reduced health sector investment and a lack of health insurance schemes. There is no pharmacovigilance system, and there are also problems with counterfeit medications. Nevertheless, Pakistan has a dynamic pharmaceutical sector ranking10th largest in the Asia-Pacific region and fulfilling 70% of the country’s medicinal demands. Many finished pharmaceutical products from Pakistan have been deemed acceptable by countries across Asia, Africa and the United States.

Taking the lead from our colleagues in medical education: the use of images of the in-vivo setting in teaching concepts of pharmaceutical science.

Despite pharmaceutical sciences being a core component of pharmacy curricula, few published studies have focussed on innovative methodologies to teach the content. This commentary identifies imaging techniques which can visualise oral dosage forms in-vivo and observe formulation disintegration in order to achieve a better understanding of in-vivo performance. Images formed through these techniques can provide students with a deeper appreciation of the fate of oral formulations in the body compared to standard disintegration and dissolution testing, which is conducted in-vitro. Such images which represent the in-vivo setting can be used in teaching to give context to both theory and experimental work, thereby increasing student understanding and enabling teaching of pharmaceutical sciences supporting students to correlate in-vitro and in-vivo processes.

Using fMRI to compare the effects of benzylpiperazine with dexamphetamine — Their differences during the Stroop paradigm

RATIONALE Benzylpiperazine (BZP) has been found to increase neural activation in the dorsal striatum when compared to placebo in response to a Stroop paradigm, in addition, subjective effects have been compared to dexamphetamine (DEX). Despite their similarities, the two have not been directly compared in respect to their effects on selective attention and inhibition. OBJECTIVES To use a double-blind placebo-controlled crossover study to compare the acute effects of BZP and DEX on executive function using functional magnetic resonance imaging (fMRI) and an event-related Stroop task. METHODS Eleven healthy participants aged 18-40 years undertook the Stroop task 90[Formula: see text]min after taking an oral dose of either BZP (200[Formula: see text]mg), DEX (20[Formula: see text]mg) or placebo. RESULTS BZP induced a greater increase in activation than DEX in the inferior frontal gyrus (IFG) during the Stroop task. DEX increased BOLD signal in the thalamus and decreased it in the IFG in comparison to placebo. CONCLUSION Despite BZP and DEX reportedly inducing similar subjective effects, there are different patterns of neural activation. We believe this differential activity is due to pharmacological differences in their receptor binding profiles and that subsequent inhibitory effects might be due to their direct effect on dopaminergic activity.

The future of pharmacy practice research – Perspectives of academics and practitioners from Australia, NZ, United Kingdom, Canada and USA

Background: Healthcare is under significant pressure with the explosion of long term conditions, shift in worldwide demographics and is evolving through advances in technology. Aligned with this is the changing role of pharmacy from the traditional dispenser of medicines to having (in addition) a more advanced clinical role. This study aimed to understand what the pharmacy practice research agenda might look like from the viewpoint of pharmacy academics and practitioners across five high‐income countries. Method: Qualitative methods were used, and thirty one‐hour interviews were undertaken with practitioners and academics from five economically advanced countries. These nations have comparable socio‐economic status but differing health systems and include; Australia, Canada, New Zealand, United Kingdom and United States of America. Six key informants were chosen from each country, three academics and three community pharmacists. A general inductive analysis was undertaken to analyse the most common and recurring themes. Results: These themes of research were based around current community pharmacy practice issues and the enablers to changing the profession. Specific areas pharmacy practice could be more involved with included long term health conditions. Some community pharmacists also believed that research into the impact of professional standards and policy change would be beneficial. The findings of this research suggest that current pharmacy practice research methods are sufficient, but need to be used more effectively. Conclusion: Participants identified a wide range of issues within community pharmacy practice. Academics largely focused on how research can be utilised in the community and how to implement findings to ensure sustainability of pharmacy practice research. Issues that community pharmacists would like to research are related to the current practice model, such as allocating time to provide patient‐focused services in addition to managing a business.

Patient access to medicines in two countries with similar health systems and differing medicines policies: Implications from a comprehensive literature review

Background: Countries with similar health systems but different medicines policies might result in substantial medicines usage differences and resultant outcomes. The literature is sparse in this area. Objective: To review pharmaceutical policy research in New Zealand and Australia and discuss differences between the two countries and the impact these differences may have on subsequent medicine access. Methods: A review of the literature (2008–2016) was performed to identify relevant, peer‐reviewed articles. Systematic searches were conducted across the six databases MEDLINE, PubMed, Science Direct, Springer Links, Scopus and Google Scholar. A further search of journals of high relevance was also conducted. Using content analysis, a narrative synthesis of pharmaceutical policy research influencing access to medicines in Australia and New Zealand was conducted. The results were critically assessed in the context of policy material available via grey literature from the respective countries. Results: Key elements regarding pharmaceutical policy were identified from the 35 research papers identified for this review. Through a content analysis, three broad categories of pharmaceutical policy were found, which potentially could influence patient access to medicines in each country; the national health system, pricing and reimbursement. Within these three categories, 9 subcategories were identified: national health policy, pharmacy system, marketing authorization and regulation, prescription to non‐prescription medicine switch, orphan drug policies, generic medicine substitution, national pharmaceutical schedule and health technology assessment, patient co‐payment and managed entry agreements. Conclusions: This review systematically evaluated the current literature and identified key areas of difference in policy between Australia and NZ. Australia appears to cover and reimburse a greater number of medicines, while New Zealand achieves much lower prices for medicines than their Australian counterparts and has been more successful in controlling national pharmaceutical expenditure. Delays in patient access to new therapies in New Zealand have considerable implications for overall patient access to medicines; however, higher patient co‐payments and relative pharmaceutical expenditure in Australia and its effect upon patient access to medicines must also be considered. HighlightsThis review has identified key areas of difference in medicines policy between Australia and NZ which could influence patient access to medicines.Both countries differ in terms regulation with parallel processing available in Australia, enhanced medicine switch in New Zealand and a lack of orphan drug legislation in New Zealand.New Zealand achieved much lower prices for medicines and has been more successful in controlling medicine expenditure while Australia appeared to fund a greater number of medicines.Delays in patient access to new therapies in New Zealand have considerable implications for access to medicines.This critical anaysis could potentially better inform policy decision‐makers when considering access to medicines.

Access to high-cost medicines in New Zealand

Abstract This chapter presents an overview of access pathways to high-cost medicines in New Zealand. It describes the avenues via the Pharmaceutical Management Agency’s (PHARMAC) access schemes and also avenues via non-PHARMAC mechanisms.

A survey study to measure the practice of patient counselling and other community pharmacy services in Jordan

To identify the type of services currently provided by community pharmacists and to explore the barriers for providing high‐quality services within the community pharmacy sector in Jordan.

Economic evaluation of prescribing conventional and newer oral anticoagulants in older adults

ABSTRACT Introduction: Anticoagulants refer to a variety of agents that inhibit one or more steps in the coagulation cascade. Generally, clinical conditions that require the prescribing of an oral anticoagulant increase in frequency with age. However, a major challenge of anticoagulation use among older patients is that this group of patients also experience the highest bleeding risk. To date, economic evaluation of prescribing of anticoagulants that includes the novel or newer oral anticoagulants (NOACs) in older adults has not been conducted and is warranted. Areas covered: A review of articles that evaluated the cost of prescribing conventional (e.g. vitamin K antagonists) and NOACs (e.g. direct thrombin inhibitors and direct factor Xa inhibitors) in older adults. Expert commentary: While the use of NOACs significantly increases the cost of the initial treatment for thromboembolic disorders, they are still considered cost-effective relative to warfarin since they offer reduced risk of intracranial haemorrhagic events. The optimum anticoagulation with warfarin can be achieved by providing specialised care; clinics managed by pharmacists have been shown to be cost-effective relative to usual care. There are suggestions that genotyping the CYP2C9 and VKORC1 genes is useful for determining a more appropriate initial dose and thereby increasing the effectiveness and safety of warfarin.