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The Availability Of Pharmacies And Pharmacy Services In The United States: 2007-2015
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pricing dossier is required, which is comparable to that needed to secure the price for a reimbursed product. For the remaining six countries (Austria, France, Germany, Greece, Netherlands, and Sweden), an abridged pricing submission is required. No pricing submission is required for Poland or Sweden. Furthermore, four countries require international reference prices from other European countries in their price submissions. Conclusions: The benefits of launching a non-reimbursed product include the ability of manufacturer to set the price and an opportunity for a faster product launch. Additionally, price publication in nine countries can help raise awareness of the non-reimbursed product to prescribers, pharmacists, and patients. Whilst the non-reimbursed price submission process is often less onerous than seeking reimbursement, local country knowledge is still essential due to significant variation in the pricing process by country. Whilst seeking a nonreimbursed launch price in Europe can be an optimal strategy for certain therapy areas, manufacturers should ensure that this approach optimizes revenues when compared to a reimbursed approach. PHP56 The Capacity Of General Practice In Hungary Between 2009-2013 Turcsányi K1, Csákvári T1, Endrei D2, Boncz I2 1University of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary
Objectives: Both hungarian and international policy directives (EU, WHO) aim to strenghten vthe gatekeeping role of general practicioners. General practices are the most important parts of the hungarian primary care system. The aim of our study is to assess the number and regional distribution of general practices, and the age structure, and work load of GP-s. Methods: Data derived from the hungarian National Healthcare Centre (NHC) and the National Health Insurance Fund Administration (NHIFA) between the years 2009-2013. Data were analyzed on national and county level as well. Number of GP-s, the staff to patient ratio, number of unfilled practices and the number of migrated GP-s was examined. Descriptive statistics (mean, distribution, chain index) was calculated. Results: Number of full-time GP-s was slightly, but continuously decreasing over the observed years (2009: 1105, 2013: 988, -10,6%). The number of general practices (2009: 6762, 2013: 6650, -1,7%), and the GP staff to patient ratio did not changed (2009: 1408, 2013: 1430, 1,14%). Number of unfilled practices was 203 in 2009, 238 in 2013 (adult: 46, children: 51, mixed: 141). The highest GP staff to patient ratio was in Pest county (1629, 1,22 times higher than in the capital), while the lowest was in Baranya county (1272, 0,95 times lower than in the capital) to 2013. Average age of GP’s was 48,26 years in 2009, it decreased to 45,97 years to 2013, and the ratio of GP-s above 50 years was also decreasing (2009: 94,5%, 2013: 64,1%, - 30,4 %). Migration of GP-s (2009: 887, 2011: 1200,(+35,3%) 2012: 1108 (-7,7%) slowed down by 2012. Conclusions: The aim of the new Act on Primary care system is to strengthen the primary care system in Hungary. Further examination is needed about the affect of the Act on the capacity of GP-s, and of the population’s health status. PHP57 Medication Affordability Among Community-Dwelling Medicare Beneficiaries Enrolled In Stand-Alone Prescription Drug Plans And Medicare Advantage Prescription Drug Plans: An Instrumental Variable Approach Yuan J, Lu K University of South Carolina, Columbia, SC, USA
Objectives: Medicare Part D improved the access and affordability of prescription drugs among Medicare beneficiaries, however, there is no published study to evaluate the impact of two part D plans, stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs), on medication affordability. The objective of this study was to compare the cost-related nonadherence (CRN) and medication affordability among elderly Medicare beneficiaries enrolled in PDPs and MA-PDs. Methods: A retrospective cross-sectional study was conducted using the national representative sample of elderly beneficiaries from Medicare Current Beneficiary Survey. Annual rates of CRN (skipping or reducing doses, not obtaining prescriptions) and medication affordability (spending less on basic needs to afford medicines) were compared among PDPs and MA-PD enrollees. In the naïve regression models, we assumed that the choice of Part D plans was exogenous, and conducted logistic regression analysis. Two-stage residual inclusion (2SRI) models were also modeled to estimate endogeneity in the choice of Part D plans. Results: Beneficiaries enrolled in PDPs were more likely to be older, female and white nonHispanics. MA-PD enrollees had lower prevalence of comorbidities and obesity. PDP enrollees showed a significantly higher prevalence of CRN than MA-PD enrollees (12.4% vs. 9.3%, p< .001), while had a similar prevalence of forgoing basic needs to afford medicines (3.9% vs. 2.9%, p= 0.06). In the naïve regression models, after adjusting for socio-demographics and clinical characteristics, PDP enrollees were more likely to report CRN (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.141.69), but had similar likelihood in spending less on basic needs to afford medicines (OR 1.35, 95% CI 0.94-2.03). 2SRI models produced similar results. Conclusions: Beneficiaries enrolled in PDP were associated with higher CRN than those enrolled in MA-PDs. Given the importance of medication adherence in controlling chronic diseases, CRN should be explicitly addressed through improving economic access to medications. PHP58 The Rate Of Clinical And Medico Legal Autopsies In Hungary 19902013 Kovács G1, Turzó C1, Endrei D2, Boncz I2 István University, GyÅ‘r, Hungary, 2University of Pécs, Pécs, Hungary
1Széchenyi
Objectives: Coherent standards apply to determining the fact of death and the classification of causes of death worldwide. Costs of the latter one are paid by the police. Current study analyzes the ratio of Hungarian mortality data and autopsy. Methods: We used data of the NHIF of Hungary and Hungarian Central Statistical Office between 1990 and 2013 (data from the year of 2014 cannot be
accessed to yet). The Medical Certificate of Cause of Death are devised around the proforma of WHO and comply with standards and classifications of diseases set out within the ICD-10. The determination of death occasionally requires autopsy. Autopsy can be required for diagnostic purposes, financed by the National Health Insurance Fund (NHIF) and autopsy is compulsory in the case of unusual deaths (accident, suicide, homicide). Results: The number of autopsies generally declines worldwide. In EU member states it has significantly declined from the ’90s until today, varying from country to country. The ratio of autopsies in Hungary was at least 10% higher in the same period than in Western-European states. In Hungary the number of deceased declines (In 1990:145660, since 2000 it is yearly approximately 130000) The rate of autopsies fell to 35% by 1995, then stabilized between 2009 and 2013 (37%). The number of medico legal autopsies has declined. (the number of unusual deaths decreased): 13.275 in 1990, 9455 in 2001, 6124 in 2013. The rate (35-37%), and the number of clinical autopsies has increased. In 2001: 38094, in 2013:41030. Conclusions: The number of autopsies internationally declines, despite of this fact, in Hungary the rate of clinical autopsies financed from health insurance increases. PHP59 The Availability Of Pharmacies And Pharmacy Services In The United States: 2007-2015 Qato D1, Zenk S1, Wilder J1, Harrington R2, Gaskin D3, Alexander C4 1University of Illinois, Chicago, IL, USA, 2University of Illinois at Chicago, Chicago, IL, USA, 3Johns Hopkins School of Public Health, Baltimore, MD, USA, 4Johns Hopkins Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, Baltimore, MD, USA
Objectives: (1) to examine trends in the availability of community pharmacies and pharmacy services in the United States overall and by pharmacy type (e.g. chain, independent) between 2007 and 2015; and (2) to determine whether and how these trends vary across local communities. Methods: Retrospective observational study using national data on the number, location and type of community pharmacies and pharmacy services from the National Council for Prescription Drug Programs. We mapped these data and linked them to the 2010 U.S. Census and the American Community Survey to derive information on community characteristics, such as racial/ethnic composition and urban vs. rural status, at the zip-code level. Results: The total number of community pharmacies increased by 6.6% from 63,279 to 67,469 during the period 2007 to 2015. A decline in pharmacy availability was only observed for grocery store pharmacies (-3.6%), which disproportionately affected urban, predominately black communities. Retail chain and independent pharmacies persistently accounted for 40% and 35% of all pharmacies, respectively. In urban, predominately minority and low-income communities, however, there were persistently fewer pharmacies and independent pharmacies were the most prevalent pharmacy type. In 2015, three-quarters of pharmacies were handicap-accessible, 27% offered home-delivery services, 18% had a drive-thru, 12% were staffed with bilingual personnel and 5% operated for 24 hours. The availability of these access-related services, however, varied across communities and pharmacy type. Chain pharmacies located in urban, predominately black communities were the least likely to offer a 24 hour service. All of these differences were statistically significant (p< 0.001). Conclusions: Despite the growth of community pharmacies in the U.S over the last eight years, the provision of access-related pharmacy services has not changed. There are persistently fewer pharmacies, particularly chains, located in predominately minority and low-income communities. Residents of black communities are disproportionately more likely encounter barriers in accessing 24-hour pharmacies. PHP60 Malnutrition Mortality In Colombian Children: An Inequalities Analysis Cárdenas-Cárdenas L1, Castillo-Rodríguez L2, Alvis-Zakzuk N1, Castañeda-Orjuela CA2, Cotes-Cantillo K1, De la Hoz Restrepo F3 1Instituto Nacional de Salud, Bogotá, Colombia, 2INSTITUTO NACIONAL DE SALUD, Bogotá, Colombia, 3Colombian National University, Bogota, Colombia
Objectives: Millions of children younger than 5 years of age die every year due to malnutrition. Most of these children live in developing countries. The aim of this study is to describe malnutrition-mortality inequalities in children under five years from Colombian municipalities. Methods: Mortality registers during 2000, 2005, 2010 and 2013 were extracted from the vital statistics of the National Administrative Department of Statistics (DANE, in Spanish) to estimate malnutrition-mortality rates per 100.000 children under five years (MMR< 5) in the Colombian municipalities. MMR< 5 were compared among groups determined by unsatisfied basics needs (UBN) quintiles as a proxy of poverty (Q1, Q2, Q3, Q4 and Q5, being the last one the poorest). Results: Colombia registered 7,533 deaths caused by malnutrition between 2000-2013, wherein 47.3% of cases were girls. The MMR< 5 was 15.5 and 6.1 per 100.000 for girls in 2000 and 2013, respectively. For the same years, the rates for boys were 19.3 and 7.3. MMR< 5 was greater in boys than in girls in all years studied. At the municipal level, the MMR< 5 for Q1 (less poverty) was the lowest for 2000, 2005, 2010 and 2013 in contrast with the others poverty quintiles. In boys, MMR< 5 was 1.5, 4.7, 3.8, 3.5 times greater in Q5 versus Q1 (low poverty) for 2000, 2005, 2010 and 2013, respectively. In girls, the differences were 3.0, 3.5, 6.1 and 11.2. Conclusions: Malnutrition mortality gaps have increased along the study period, especially in girls. Public health policies should be addressed to avoid malnutrition deaths in children under five years. PHP61 Examination Of Nurses’ And Nursing Students’ Views On Working Abroad Oláh A1, Bogos A1, Müller Á1, Pakai A2, Füge K1, Boncz I1, Gelencsér E3, Fusz K1 1University of Pécs, Pécs, Hungary, 2University of Pécs, Zalaegerszeg, Hungary, 3University of Pécs, Kaposvár, Hungary
Objectives: Working abroad is becoming highly popular in Hungary, which causes shortage in nursing professionals at certain territories of the healthcare system.
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
pricing dossier is required, which is comparable to that needed to secure the price for a reimbursed product. For the remaining six countries (Austria, France, Germany, Greece, Netherlands, and Sweden), an abridged pricing submission is required. No pricing submission is required for Poland or Sweden. Furthermore, four countries require international reference prices from other European countries in their price submissions. Conclusions: The benefits of launching a non-reimbursed product include the ability of manufacturer to set the price and an opportunity for a faster product launch. Additionally, price publication in nine countries can help raise awareness of the non-reimbursed product to prescribers, pharmacists, and patients. Whilst the non-reimbursed price submission process is often less onerous than seeking reimbursement, local country knowledge is still essential due to significant variation in the pricing process by country. Whilst seeking a nonreimbursed launch price in Europe can be an optimal strategy for certain therapy areas, manufacturers should ensure that this approach optimizes revenues when compared to a reimbursed approach. PHP56 The Capacity Of General Practice In Hungary Between 2009-2013 Turcsányi K1, Csákvári T1, Endrei D2, Boncz I2 1University of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary
Objectives: Both hungarian and international policy directives (EU, WHO) aim to strenghten vthe gatekeeping role of general practicioners. General practices are the most important parts of the hungarian primary care system. The aim of our study is to assess the number and regional distribution of general practices, and the age structure, and work load of GP-s. Methods: Data derived from the hungarian National Healthcare Centre (NHC) and the National Health Insurance Fund Administration (NHIFA) between the years 2009-2013. Data were analyzed on national and county level as well. Number of GP-s, the staff to patient ratio, number of unfilled practices and the number of migrated GP-s was examined. Descriptive statistics (mean, distribution, chain index) was calculated. Results: Number of full-time GP-s was slightly, but continuously decreasing over the observed years (2009: 1105, 2013: 988, -10,6%). The number of general practices (2009: 6762, 2013: 6650, -1,7%), and the GP staff to patient ratio did not changed (2009: 1408, 2013: 1430, 1,14%). Number of unfilled practices was 203 in 2009, 238 in 2013 (adult: 46, children: 51, mixed: 141). The highest GP staff to patient ratio was in Pest county (1629, 1,22 times higher than in the capital), while the lowest was in Baranya county (1272, 0,95 times lower than in the capital) to 2013. Average age of GP’s was 48,26 years in 2009, it decreased to 45,97 years to 2013, and the ratio of GP-s above 50 years was also decreasing (2009: 94,5%, 2013: 64,1%, - 30,4 %). Migration of GP-s (2009: 887, 2011: 1200,(+35,3%) 2012: 1108 (-7,7%) slowed down by 2012. Conclusions: The aim of the new Act on Primary care system is to strengthen the primary care system in Hungary. Further examination is needed about the affect of the Act on the capacity of GP-s, and of the population’s health status. PHP57 Medication Affordability Among Community-Dwelling Medicare Beneficiaries Enrolled In Stand-Alone Prescription Drug Plans And Medicare Advantage Prescription Drug Plans: An Instrumental Variable Approach Yuan J, Lu K University of South Carolina, Columbia, SC, USA
Objectives: Medicare Part D improved the access and affordability of prescription drugs among Medicare beneficiaries, however, there is no published study to evaluate the impact of two part D plans, stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug plans (MA-PDs), on medication affordability. The objective of this study was to compare the cost-related nonadherence (CRN) and medication affordability among elderly Medicare beneficiaries enrolled in PDPs and MA-PDs. Methods: A retrospective cross-sectional study was conducted using the national representative sample of elderly beneficiaries from Medicare Current Beneficiary Survey. Annual rates of CRN (skipping or reducing doses, not obtaining prescriptions) and medication affordability (spending less on basic needs to afford medicines) were compared among PDPs and MA-PD enrollees. In the naïve regression models, we assumed that the choice of Part D plans was exogenous, and conducted logistic regression analysis. Two-stage residual inclusion (2SRI) models were also modeled to estimate endogeneity in the choice of Part D plans. Results: Beneficiaries enrolled in PDPs were more likely to be older, female and white nonHispanics. MA-PD enrollees had lower prevalence of comorbidities and obesity. PDP enrollees showed a significantly higher prevalence of CRN than MA-PD enrollees (12.4% vs. 9.3%, p< .001), while had a similar prevalence of forgoing basic needs to afford medicines (3.9% vs. 2.9%, p= 0.06). In the naïve regression models, after adjusting for socio-demographics and clinical characteristics, PDP enrollees were more likely to report CRN (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.141.69), but had similar likelihood in spending less on basic needs to afford medicines (OR 1.35, 95% CI 0.94-2.03). 2SRI models produced similar results. Conclusions: Beneficiaries enrolled in PDP were associated with higher CRN than those enrolled in MA-PDs. Given the importance of medication adherence in controlling chronic diseases, CRN should be explicitly addressed through improving economic access to medications. PHP58 The Rate Of Clinical And Medico Legal Autopsies In Hungary 19902013 Kovács G1, Turzó C1, Endrei D2, Boncz I2 István University, GyÅ‘r, Hungary, 2University of Pécs, Pécs, Hungary
1Széchenyi
Objectives: Coherent standards apply to determining the fact of death and the classification of causes of death worldwide. Costs of the latter one are paid by the police. Current study analyzes the ratio of Hungarian mortality data and autopsy. Methods: We used data of the NHIF of Hungary and Hungarian Central Statistical Office between 1990 and 2013 (data from the year of 2014 cannot be
accessed to yet). The Medical Certificate of Cause of Death are devised around the proforma of WHO and comply with standards and classifications of diseases set out within the ICD-10. The determination of death occasionally requires autopsy. Autopsy can be required for diagnostic purposes, financed by the National Health Insurance Fund (NHIF) and autopsy is compulsory in the case of unusual deaths (accident, suicide, homicide). Results: The number of autopsies generally declines worldwide. In EU member states it has significantly declined from the ’90s until today, varying from country to country. The ratio of autopsies in Hungary was at least 10% higher in the same period than in Western-European states. In Hungary the number of deceased declines (In 1990:145660, since 2000 it is yearly approximately 130000) The rate of autopsies fell to 35% by 1995, then stabilized between 2009 and 2013 (37%). The number of medico legal autopsies has declined. (the number of unusual deaths decreased): 13.275 in 1990, 9455 in 2001, 6124 in 2013. The rate (35-37%), and the number of clinical autopsies has increased. In 2001: 38094, in 2013:41030. Conclusions: The number of autopsies internationally declines, despite of this fact, in Hungary the rate of clinical autopsies financed from health insurance increases. PHP59 The Availability Of Pharmacies And Pharmacy Services In The United States: 2007-2015 Qato D1, Zenk S1, Wilder J1, Harrington R2, Gaskin D3, Alexander C4 1University of Illinois, Chicago, IL, USA, 2University of Illinois at Chicago, Chicago, IL, USA, 3Johns Hopkins School of Public Health, Baltimore, MD, USA, 4Johns Hopkins Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, Baltimore, MD, USA
Objectives: (1) to examine trends in the availability of community pharmacies and pharmacy services in the United States overall and by pharmacy type (e.g. chain, independent) between 2007 and 2015; and (2) to determine whether and how these trends vary across local communities. Methods: Retrospective observational study using national data on the number, location and type of community pharmacies and pharmacy services from the National Council for Prescription Drug Programs. We mapped these data and linked them to the 2010 U.S. Census and the American Community Survey to derive information on community characteristics, such as racial/ethnic composition and urban vs. rural status, at the zip-code level. Results: The total number of community pharmacies increased by 6.6% from 63,279 to 67,469 during the period 2007 to 2015. A decline in pharmacy availability was only observed for grocery store pharmacies (-3.6%), which disproportionately affected urban, predominately black communities. Retail chain and independent pharmacies persistently accounted for 40% and 35% of all pharmacies, respectively. In urban, predominately minority and low-income communities, however, there were persistently fewer pharmacies and independent pharmacies were the most prevalent pharmacy type. In 2015, three-quarters of pharmacies were handicap-accessible, 27% offered home-delivery services, 18% had a drive-thru, 12% were staffed with bilingual personnel and 5% operated for 24 hours. The availability of these access-related services, however, varied across communities and pharmacy type. Chain pharmacies located in urban, predominately black communities were the least likely to offer a 24 hour service. All of these differences were statistically significant (p< 0.001). Conclusions: Despite the growth of community pharmacies in the U.S over the last eight years, the provision of access-related pharmacy services has not changed. There are persistently fewer pharmacies, particularly chains, located in predominately minority and low-income communities. Residents of black communities are disproportionately more likely encounter barriers in accessing 24-hour pharmacies. PHP60 Malnutrition Mortality In Colombian Children: An Inequalities Analysis Cárdenas-Cárdenas L1, Castillo-Rodríguez L2, Alvis-Zakzuk N1, Castañeda-Orjuela CA2, Cotes-Cantillo K1, De la Hoz Restrepo F3 1Instituto Nacional de Salud, Bogotá, Colombia, 2INSTITUTO NACIONAL DE SALUD, Bogotá, Colombia, 3Colombian National University, Bogota, Colombia
Objectives: Millions of children younger than 5 years of age die every year due to malnutrition. Most of these children live in developing countries. The aim of this study is to describe malnutrition-mortality inequalities in children under five years from Colombian municipalities. Methods: Mortality registers during 2000, 2005, 2010 and 2013 were extracted from the vital statistics of the National Administrative Department of Statistics (DANE, in Spanish) to estimate malnutrition-mortality rates per 100.000 children under five years (MMR< 5) in the Colombian municipalities. MMR< 5 were compared among groups determined by unsatisfied basics needs (UBN) quintiles as a proxy of poverty (Q1, Q2, Q3, Q4 and Q5, being the last one the poorest). Results: Colombia registered 7,533 deaths caused by malnutrition between 2000-2013, wherein 47.3% of cases were girls. The MMR< 5 was 15.5 and 6.1 per 100.000 for girls in 2000 and 2013, respectively. For the same years, the rates for boys were 19.3 and 7.3. MMR< 5 was greater in boys than in girls in all years studied. At the municipal level, the MMR< 5 for Q1 (less poverty) was the lowest for 2000, 2005, 2010 and 2013 in contrast with the others poverty quintiles. In boys, MMR< 5 was 1.5, 4.7, 3.8, 3.5 times greater in Q5 versus Q1 (low poverty) for 2000, 2005, 2010 and 2013, respectively. In girls, the differences were 3.0, 3.5, 6.1 and 11.2. Conclusions: Malnutrition mortality gaps have increased along the study period, especially in girls. Public health policies should be addressed to avoid malnutrition deaths in children under five years. PHP61 Examination Of Nurses’ And Nursing Students’ Views On Working Abroad Oláh A1, Bogos A1, Müller Á1, Pakai A2, Füge K1, Boncz I1, Gelencsér E3, Fusz K1 1University of Pécs, Pécs, Hungary, 2University of Pécs, Zalaegerszeg, Hungary, 3University of Pécs, Kaposvár, Hungary
Objectives: Working abroad is becoming highly popular in Hungary, which causes shortage in nursing professionals at certain territories of the healthcare system.