Lecture 08: Important Influencing Data (factors)

1. Lecture 08:Important Influencing Data (factors) For Drug Utilization Studies JAMASOFT2017

2. The socio-demographic data, which can be necessary for any evaluation of the consumer market for prescription drugs as well OTC drugs, must include the following characteristics of the population: • Age, • Gender, • Marital Status, • Income, • Geographic location. JAMASOFT2017

3. AGE. The relative proportion of the population in each of the age categories is important for purposes of forecasting demand for an individual class of prescription products as well as OTC products. Particularly important segments for the pharmaceuticals are the age categories: 0-19and 60-79years. JAMASOFT2017

4. The 0-19 and 60-79 age categories. Not only do these groups offer specialised product development opportunities, but they are the two categories best represented in developing government health-care programs. A further consideration is the fact that these two segments of the population demand proportionately more health-care than other segments of the population. JAMASOFT2017

5. GENDER is an important demographic characteristic from the pharmaceutical viewpoint. The womenaccount for significantly more than their share of the health-care market, prescription drugs included. JAMASOFT2017

6. MARITAL STATUS might seem at first glance to have little direct bearing on the prescription drug market, this is certainly not the case. Indirectly, of course, marital status AFFECTS THE NUMBER OF BIRTHS, with attendant effects on the demand generated thereby. JAMASOFT2017

7. INCOME determines the total available money for expenditure on drug products, it is extremely important. A further consideration is the importance on income levels in determining the type and level of health-care purchases. A family income growes, expenditures for medicines also growe. JAMASOFT2017

8. INCOME Important rule: Expenditures for medicines rose as the education of the head of the family is greater. This is almost certainly a reflection of the greater average earnings of the better educates, and certainly no data exist to allow any interpretation of the possible effects of education on expenditures for medicines. JAMASOFT2017

9. GEOGRAPHIC LOCATION. Heterogeneity in the marketplace is most in evidence at the retail level. Each pharmacy is truly unique inat least one respect – location. The location of a community pharmacy may be a critical factor. JAMASOFT2017

10. GEOGRAPHIC LOCATION. Pharmacies have traditionally been located in close proximity to physicians. There is a particular value in receiving a patient‘s first prescription because of the potential for refills as well as prescriptions of population. Socioeconomic qualities of the population in the immediate area of the pharmacy location play an important role with consequences on success level. JAMASOFT2017

11. Age-related increasesin diseases incidence and prevalencereflect intreatment intensity. Ageing of the population (i.e. the increasing proportion of elderly and middle-aged) has been pointed out as a major driver of rising healthcare expenditure. JAMASOFT2017

12. Definition of an older or elderly person (WHO). Most developed world countries have accepted the chronological age of 65 years and moreas a definition of 'elderly' or older person, but like many westernized concepts, this does not adapt well tothe situation in Africa. While this definition is somewhat arbitrary, it is many times associated with the age at which one can begin to receive pension benefits. JAMASOFT2017

13. Thus, the elderly is defined as people 65 years or older. These people use more pharmaceutical products than any other age segments. JAMASOFT2017

14. Age-relatedphysiologicchangesin human body alter the pharmacokinetic and pharmacodynamic propertiesof many drugs. JAMASOFT2017

15. More over: The incidence of ADEs (adverse drug events)in the elderly variesfrom 5% to 35%, depending on the method used to define and measurethe event. Adverse drug events may result in the need for additionalmedications, disability, decreased quality of life and functioning,hospitalisation, or death. JAMASOFT2017

16. People age sixty-five and over make up approximately 13 percent of the total population, yet they consume about 40 percentof all medications. This rate of medication use among seniors coincides with the rate of many chronic diseases, which rise sharply with age. For example, arthritis, high blood pressure, and angina are reported by 47 percent, 43 percent, and 31 percent, respectively, by people age sixty-five years or older. JAMASOFT2017

17. The consequence: The demographic impact on pharmaceutical expenditures. JAMASOFT2017

18. The elderly population is one of the most rapidly increasing populations in the world. Physiological alterations induced by the aging process make these individuals more susceptible to chronic diseases and, consequently, to increased drug utilization. Cardiovascular system drugs represented the pharmacological class most used by the elderly. JAMASOFT2017

19. In last years and in almost every countryincreasing numbers of consumers of pharmacy services will be older adults.Consequences for the pharmacy: • There are changing demographics of the population. • There is a disproportionate use of medications by older adults. • The magnitude of medication use by older adults is the factors influencing their prescription and medication purchases. • The aging of the society makes it imperative that community pharmacies respond effectively to the needs and desires of older consumers. JAMASOFT2017

20. Elderly people - when ill, 72 % of these individuals visited the doctor, while 28% self-medicated or combined. For the majority (50.2%), drugs were identified by their labels. Only 41.2% of the elderly understood medical prescriptions and 68.3% of the patients studied obtained the necessary information for the appropriate use of therapy from their doctors. JAMASOFT2017

21. CONSEQUENCES. Forthepharmaceutical care programs for the treatment, prevention, and use of medications may provide a higher efficiency to elderly drug therapy. The incorrect use of medicines is one of the greatest problems experienced by this population. JAMASOFT2017

22. The elderly often use more than one medicine, which may lead to drug interactions, adverse effects, concomitant use of other therapies and drug redundancy, and the use of drugs without therapeutic value. These events are, for the most part, related to pharmacodynamic and pharmacokinetic changes that occur at this age. JAMASOFT2017

23. Since an appropriate pharmacotherapy can minimise the symptoms of diseases and diminish mortality and morbidity indexes, population-based studies are needed to identify and quantify the most frequent prescription errors and their associated causes, providing numbers that can be analysed and allowing for the identification of problems. JAMASOFT2017

24. Theaging of the general population in industrialized countries has brought to public attention the increasing incidence of age-related clinical conditions, because the long-term impact of diseases on functional status and on costs are greater in older people than in any other age group. JAMASOFT2017

25. Furthermore, there are major factors affecting the management of the pharmaceutical care in older people: e.g. inappropriate prescribing, lack of adherence and compliance, and the burden of adverse drug events. The assessment of these factors should be considered a priority in pharmacoeconomic evaluations in the aging population, referring to particular settings or conditions and diseases, such as the presence of cardiovascular risk factors, diabetes and chronic pain. JAMASOFT2017

26. Based on our long-term observations, the drug consumption is age-related and it can be expressed bytheSaturation Growth-Rate Model. local maximum about 60 – 79 years local minimum about 20 - 29 drug consumption level JAMASOFT2017 human age

27. Some other consequences for pharmacy services: • The elderly will no doubt force many changes in the manner in which pharmaceutical products and pharmacy services are delivered to the public. • The elderly use more pharmaceutical products than any other age segment. JAMASOFT2017

28. These facts are associatedwith the prevalence of chronic illnesses withinthe process of aging. • For the younger population segments, the illnesses acquired are usually acute, and thus drug therapy when given is normally short-term, that is, less than 30 days. • However, for the elderly and their chronic diseases, drug therapy in the majority of cases is either needed to sustain life such as cardiac medications or is needed so that the individual can perform his / her daily living functions. JAMASOFT2017

29. Drug therapies for the elderly may last for years and most likely up until death. Another problem for many older people is that they have more than one health problem and each disease problem usually requires a different drug therapy. These multiple drug therapies, “polypharmacy- polypragmasy” require a greater understanding in regard to their use, directions, side effects, contraindications and increase the potential of drug interactions. JAMASOFT2017

30. The older people has other physical limitations that may cause problemsin understanding and taking prescribed medications. • Some of the elderly may not be able to read the drug label and drug information brochures because of poor vision. • Problems in hearing may be another physical problem which at times may impede the elderly´s full understanding of what the health care practitioner communicates. • Some elderly are too embarrassed to bother health care practitioners with what they believe are irrelevant or “stupid” questions. JAMASOFT2017

31. The older people has other physical limitations that may cause problemsin understanding and taking prescribed medications. • Others may be physically impaired which may cause problems in opening drug containers, measuring correct drug amounts if they are in a liquid dosage form, or they may have problems swallowing or chewing medication, especially the latter if dentures are not suitable. • All of these shortcomings have the potential of precipitating a misuse of prescribed medications. JAMASOFT2017

32. Nowadays, drug therapy is the most cost – effective therapy atallavailable, but to really maximise its effects, efforts must be made to assure that the elderly understand and use their medications correctly. JAMASOFT2017

33. Thanks for your attention. JAMASOFT2017