Rosemin Kassam

Background:The burden of cost of prescription medications for chronic conditions is substantial. Many patients do not take their medication as prescribed due to cost. In 2010 the government of British Columbia introduced policy changes that reduced generic prices over a period of four years. I studied the impact of five generic price reductions policy on adherence to statin medications. Methods: Using data from the British Columbia Ministry of Health through Population Data BC, I analyzed prescription claims of 433,945 residents who were on statins from 2008 to 2014. I measured medication adherence using proportion of days covered (PDC) with brand name statin users as my control group. Interrupted time series analysis was used to compare longitudinal trends before and after policy changes. Results: Residents on brand name statins on average had 89.9% (95% CI 0.8924 to 0.9059) proportion of days covered with medication prior to policy interventions. Pre-existing level of adherence to generic statins was 0.89 percentage points (-0.0007 to 0.0184) higher relative to the control. There was a sustained significant decrease of 0.05 percentage points (-0.0009 to -0.00001) per month in trend of brand name use (p=0.0473). Adherence to generics dropped by 0.02 percentage points (-0.0009 to 0.0005) relative to the control over the 24 months preceding policy interventions. After first policy intervention, adherence to brand name statins increased immediately by 1.1 percentage points (-0.0032 to 0.0245) while generics utilization decreased by 0.71 percentage points (-0.0267 to 0.0125) relative to the control. Trend in control decreased by 0.03 percentage points (-0.0026 to 0.0021). After the first policy, there was a rise in trend of generics adherence of 0.27 percentage points (-0.0006-0.0061) per month relative to the control. Further price reductions resulted in moderate improvement in adherence to generic statins. Conclusion:Findings indicate that reductions in generic drug prices in BC yielded a modest improvement in pharmaceutical claims for statins. In the future, health policy makers may want to consider fewer but larger drug price reduction interventions for a more effective impact on medication adherence.

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Background: It has been estimated that there are 4000 licensed drug shops throughout Ugandawith approximately 39% being unlicensed and unregulated with the latter being common inrural areas. Unregulated drug vendors play a major role in malaria management for youngchildren (age five and under) since they are often the first points of access for caregiversseeking treatment for their sick children. As a result, their ability to manage malaria has a greatinfluence on malaria outcomes in the rural community.Objective: The study assessed practices of unregulated drug vendors related to casemanagement for children five and under. Knowledge, attitudes and beliefs in other areas ofmalaria management were also assessed to better understand their practices.Methods: This study employed a descriptive and qualitative design using a semi-structuredinterview. A district-wide census identified 88 unlicensed, unregulated drug vendors in which75 participants were recruited into the study through a purposive sampling strategy.Results: The study found that a large proportion of drug vendors were unqualified to operate adrug shop. Several flaws in their practices were identified including vendors dispensing quinineinstead of first-line ACT, irrational poly-pharmacy, dispensing oral quinine indiscriminately,providing under-dose treatment and selling ineffective antimalarials. Only 26.7% of vendorsstocked ACTs while 90.7% stocked quinine (oral). Only 27.9% reported ACT as the best option totreat malaria, while others believed in less effective medicines. Some vendors also offeredresponses to questions that indicated incorrect beliefs related to cause, prevention, and effectiveness of different antimalarials. Although many were unqualified and demonstrated poor knowledge, beliefs and practices related to malaria management, many were interested in participating in future programs. About 89.0% expressed preference for short-term training sessions. Conclusion: Small proportion of drug vendors stocking ACTs suggests effective treatment of malaria at home may be compromised due to clients and children likely receiving less effective antimalarials for treatment. The findings also call for a program to deliver training to unregulated vendors to enhance treatment practices and also correcting misconceptions and flawed beliefs in other areas of malaria management.

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