Health Management

Background: The continuing increase of pharmaceutical expenditure calls for new approaches to pricing and reimbursement of pharmaceuticals. Value based pricing of pharmaceuticals is emerging as a useful tool and possess theoretical attributes to help health system cope with rising pharmaceutical expenditure. Aim: To assess the feasibility of introducing a value-based pricing scheme of pharmaceuticals in Cyprus and explore the integrative framework.

Empirical data suggest that children with infrequent tobacco use have difficulty quitting smoking. Data were obtained from the nationally representative Global Youth Tobacco Survey of middle-school students in Cyprus and Greece. Regression analyses examined associations between smoking frequency (smoking days per month or cigarettes smoked per day) and loss of autonomy (difficulty refraining from smoking). The prevalence of lost autonomy was 40% among subjects who smoked 1 or 2 days/month and 41% among subjects who averaged less than one cigarette/day and increased in a dose-response pattern. Regression models derived from the Cyprus data were replicated by the Greek data. Two national surveys confirm previous reports of difficulty with smoking cessation with infrequent smoking. Since loss of autonomy is universally recognised as a core feature of addiction, our data indicate that young adolescents experience symptoms of nicotine addiction with infrequent tobacco use.

Background: Fatigue and burnout are two concepts often linked in the literature. However, regardless of their commonalities they should be approached as distinct concepts. The current and ever-growing reforms regarding the delivery of nursing care in Cyprus, stress for the development of ways to prevent burnout and effectively manage fatigue that can result from working in stressful clinical environments.

This paper examines issues related to various decision-based analytic approaches to sequential choice of projects, with special motivation from and application in the pharmaceutical industry. In particular, the Pearson index and Gittins index are considered as key strategic decision-making tools for the selection of R&D projects. It presents a proof of optimality of the Pearson index based on the Neyman-Pearson lemma. Emphasis is also given to how a project manager may differentiate between the two indices based on concepts from statistical decision theory. This work demonstrates and justifies the correct use of the Pearson index.

The confirmatory factor analysis of the job diagnostic survey: the oncology nursing setting ANDREAS CHARALAMBOUS P h D ( O n c o l o g y N u r s i n g ) 1 , VASILIOS RAFTOPOULOS P h D ( Q u a l i t y C a r e ) 2 and MICHAEL A. TALIAS P h D ( S t a t i s t i c s ) 3 1 Lecturer, Head The confirmatory factor analysis of the job diagnostic survey: the oncology nursing setting

Transradial access is an alternative to the transfemoral approach in coronary interventions. It results in less access-site bleeding, shorter hospital stays, lower costs, and less pain for the patient. However, some authors have suggested that the transradial approach might lead to radial artery occlusion, which precludes repeated same-artery catheterizations. Using data from our center, we evaluated the feasibility, safety, and efficacy of repeated transradial catheterization.

Background. Cyprus has been procuring medicines for the public sector through tendering and is one of a few EU member states with this policy both in outpatient and inpatient health sector. Objectives. The aim of this paper is the assessment of financial benefit from tendering and evaluation of its operational framework. Data and Methods We compare value (weighted price) reduction, from a public payer's perspective, by using tendering prices compared with official pharmacy procurement prices, for the same volume of products (strength and package). Moreover, we assess mean price reduction of official pharmacy procurement prices as an effect of tendering, for the same sample. We perform the same analysis for the total sample and for 3 overlapping subcategories: branded, generics and Top twenty products in value. Products were selected based on clinical importance, volume and value. Sample includes 176 products, corresponding to 49.3 million euro cost and relevant data were extracted from Public Pharmaceutical sales of 2011 and the official 2011 pricelist of Ministry of Health. Results. 60,6 % value reduction and 39,39 % mean price reduction have been achieved with tendering system. Generics demonstrated the greatest reduction both in value (94.8%) and in mean price (62,97%).Branded products reached 33,4% value and 25,99% mean price reduction, while Top Twenty products achieved 29% value and 23 % mean price reduction. Conclusion. Tendering is emerging as a sustainable and potent solution to a fast expanding pharmaceutical sector and it's a context sensitive cost containment approach. It must be implemented within a transparent, strict and specific framework. Highlights • We assess impact on tendering on pharmaceutical expenses • We assess both inpatient and outpatient sector prices • Tendering is a potent procurement approach • It's a multifactorial process with many possible interactions and complications • Proper planning is essential

Background: Tendering has been a promising approach for procuring pharmaceuticals. Significant price reductions have been well documented by several authors. To our knowledge, there are limited data detailing the impact of variables in the tendering process. Objectives: In this article, our objective was to evaluate the impact of potentially exploratory variables, which included innovation status, total value and volume of sales of each product, health care setting administration (hospital/outpatient), patent status (branded/generic), tendering type, and wholesale price, on price reduction in the tendering process. Methods: Financial data of public sector sales during 2011 were analyzed. On the basis of these data, we selected 178 medicines with corresponding sales of €49 million, out of a total market value of €104 million. Medicines were selected according to volume, value, and therapeutic value across all therapeutic areas. We performed a beta regression for the assessment of impact of variables and applied the same methodology to different subgroups. Conclusions: The generic status of medicines is statistically significantly associated with a higher price reduction. Tendering type by alternative, high wholesale prices, and high volume are robust estimators for price reduction. Innovation status does not have any effect on price reduction. Outpatient medicines reach lower prices as compared with hospital medicines. A rather unexpected finding is the negative correlation of high sales value with price reduction. These findings will lead to better understanding of the tendering framework, enabling us to further evolve its operational capacity, aiming to generate more savings. Moreover, our study indicates areas in which a more optimized approach is needed.

Background: Financial recession mandated the introduction of harsh austerity measures. Health, and particularly pharmaceuticals, constitute a significant part of public expenditure and as such they have been subject to significant budget reduction and stringent policies. As a consequence of these measures, an increasing percentage of patients resort to private sector for acquisition of their prescribed pharmaceuticals, due to exclusion of public health care beneficiary status, reduction of breadth of national formularies, delays in reimbursement and excessive waiting times. Affordability for pharmaceuticals in the private sector is of paramount importance since household disposable income plummets and more people are prone to impoverishment. This is critical for branded products, whose active substance and trademark are under patent protection, since no alternative options exist while their monopoly status imply that their prices are high. The impact on affordability regarding access of patient to necessary pharmaceutical care has not been documented in developed countries. Methods: A laspeyer index was constructed to compare prices of branded pharmaceuticals and assess affordability, by adjusting price index with Gross Domestic Product Purchase Power Parity per capita. Laspeyer index compares prices based on weights, which in our study are the corresponding sales of products in Cyprus. Moreover, we define the percentage of population that will face catastrophic pharmaceutical expenditure after acquisition of one product from eight major and common therapeutic categories. We used data from five European recession countries: Italy, Portugal, Spain, Greece and Cyprus, for 48 products which were selected based on sales. Results: Cyprus displays the highest prices for pharmaceuticals. By adjusting for Gross Domestic Product Purchase Power Parity per capita, affordability is worst for Cyprus and Portugal. Conclusions: As more patients have to resort to private sector for provision of adequate and timely healthcare, health agencies must reassess affordability of medicines and minimise catastrophic expenditure impact. Health agencies should primarily try to enhance efficiency of the system and reduce waste, instead of resorting to blunt budget reduction, which can demonstrate unpredictable consequences in public health.

Background: The mental health of the population consists of the three essential pillars of quality of life, economy, and society. Mental health services take care of the prevention and treatment of mental disorders and through them maintain, improve, and restore the mental health of the population. The purpose of this study is to describe the methodology for qualitative and quantitative evaluation and improvement of the mental health service system. Methods: This is a narrative review study that searches the literature to provide criteria, indicators, and methodology for evaluating and improving the quality of mental health services and the related qualitative and quantitative indicators. The bibliography was searched in popular databases PubMed, Google Scholar, CINAHL, using the keywords “mental”, “health”, “quality”, “indicators”, alone or in combinations thereof. Results: Important quality indicators of mental health services have been collected and presented, and modified where ...

Talent Management (T.M.) constitutes a modern and emerging research area in Human Resources Management (HRM). Using a systematic literature approach, we searched in Talent Management literature in the healthcare sector context. We conclude that the number of related studies is minimal. The benefits of implementing Talent Management strategies in healthcare organizations are essential for the organization’s sustainable development and the talented staff and healthcare services patients. Our goal is to undertake a systematic literature review to identify these factors related to talent management practices suitable for healthcare organizations and professionals. We have conducted, according to PRISMA guidelines, a systematic literature review (2010–2020) in the electronic databases PubMed, CINAHL, Cochrane Database of Systematic Reviews, Health Source/Nursing Academic Edition. Search terms related to T.M. were (“Talent Management” AND “Talent Healthcare”). Strict inclusion and exclusi...

We identify, synthesize, and evaluate the drivers and outcomes of exercised power in buyerseller relationships, based on a meta-analysis of extant empirical research. Using information extracted from a content analysis of 120 studies found in 103 articles and published in 37 journals, we propose and test an integrative conceptual model comprising one antecedent factor (i.e., dependence) and two outcome aspects (i.e., conflict, satisfaction) of six forms of exercised power, which are divided into coercive (i.e., coercive, reward, legalistic) or noncoercive (i.e., referent, expert, information). Using structural equation modeling, we confirm the vast majority of the hypothesized associations between antecedents and variants of exercised power, as well as between exercised power and outcome dimensions. Important theoretical and managerial implications are derived from this meta-analysis, as well as directions for future research.

The specific attributes of agrifood supply chains, along with their importance for the economy and society, have led to an increased interest in the parameters that enhance their effectiveness. Recently, numerous digital tools aimed at improving supply chain effectiveness have been developed. The majority of existing research focuses on optimizing individual processes rather than the overall growth of a food supply chain. This study aims to identify the stages of the information systems planning (ISP) process that affect the success of developing a strategic decision support system (DSS) for improving the decision-making process in the agrifood supply chains. Data were collected from 66 IT executives from Greek small and medium-sized enterprises (SMEs) in the agrifood sector and analyzed using regression analysis. The results revealed that situation analysis is the only stage of ISP that predicts ISP success. These findings can assist managers in appreciating the critical role of IS...

This study compares EQ-5D-3L, EQ-5D-5L, and SF-6D utilities in patients with different musculoskeletal (MSK) disorders, also differing in disease severity as defined by valid clinical indexes. Utilities were measured from a cross-sectional sample of rheumatoid arthritis (N = 114), psoriatic arthritis (N = 57), ankylosing spondylitis (N = 49), and osteopenia/osteoporosis (N = 95) patients. For the first three groups, disease activity (severity) was measured with the DAS-28, DAPSA, and BASDAI clinical indexes, respectively. Mean differences and effect sizes were measured, and agreement between utilities was estimated with the intraclass correlation coefficient and Bland–Altman plots. Higher agreement was observed between EQ-5D-5L and SF-6D, compared to EQ-5D-3L and SF-6D, in all MSK disorder groups and severity levels. In groups with moderate to high severity, agreement between EQ-5D-3L/SF-6D and EQ-5D-5L/SF-6D was between low and fair, and both EQ-5D-3L and 5L utilities were lower th...