Background The rapid expansion of e-pharmacy platforms has shifted over-the-counter (OTC) medicine selection from physical pharmacies to digital environments, where consumers increasingly rely on online product pages for safety-critical information. For women’s health OTC products, this shift raises particular concerns due to pregnancy- and lactation-related risks, frequent self-care use, and reduced access to professional counseling at the point of purchase. Despite growing reliance on e-pharmacies, evidence on the completeness of online safety information across regulatory contexts remains limited.Methods A cross-sectional observational study assessed the transparency of safety information for women’s health OTC medicines and supplements sold on licensed e-pharmacy platforms across seven markets (United States, United Kingdom, Canada, Australia; United Arab Emirates, Saudi Arabia, Qatar). Product pages were evaluated using a standardized 12-item transparency framework capturing essential safety elements. Comparative analyses employed nonparametric tests and multivariable regression to identify regional, platform-level, and product-related predictors of transparency.Results A total of 119 products were analyzed. The mean Transparency Score was 6.25 (SD 1.81) out of 12, indicating moderate completeness. Critical elements, including expiry date, batch or lot number, and drug interaction information, were rarely disclosed. While overall transparency differed modestly by region, warnings and precautions were significantly less likely to appear on Middle Eastern platforms. Independent or regional pharmacies demonstrated lower transparency than chain platforms. Pregnancy and lactation guidance was inconsistently provided outside pregnancy-specific categories.Conclusion Licensed e-pharmacy platforms frequently provide incomplete safety information for women’s health OTC products, with meaningful variation by market region, platform type, and availability of supplementary digital resources. Transparency deficits are embedded within regulated digital pharmacy systems rather than limited to illicit sellers. These findings underscore the need for harmonized regulatory standards, mandatory digital safety disclosures, and strengthened platform accountability to support safe, informed self-care in online pharmacy environments.
Introduction In recent years, OTC distribution has expanded into non-pharmacy retail settings, with 19 of 30 European countries permitting non-pharmacy OTC sales. This may increase accessibility and promote self-medication, but it also creates risks of misuse, overdose, and greater retail market concentration. Therefore, countries have adopted various regulatory mechanisms to balance accessibility with patient safety. This scoping review aimed to examine the global regulatory models governing OTC dispensing and distribution at non-pharmacy retail settings, with particular emphasis on regulatory mechanisms influencing availability and accessibility.Methods A scoping review was conducted following the PCC framework and reported in accordance with PRISMA-ScR and JBI guidance. Literature published between January 2015 and August 2025 was identified through PubMed/MEDLINE, Scopus, ScienceDirect, and citation searching. Eligible studies were selected through systematic screening and synthesised using thematic analysis.Results The search identified 295 studies, followed by the removal of 15 duplicates. After screening 280 unique studies, 8 met the inclusion criteria. Data from empirical studies and regulatory documents were synthesised. Three major themes were identified; the first was regulation and supervision, including medication classification, dispensing, pack-size limits, age restrictions, and oversight mechanisms. The second was self-medication and consumer behaviour, showing convenience-driven purchasing and limited risk awareness. The third was deregulation and service system changes, indicating expanded access through supermarkets, convenience stores, and online platforms, alongside concerns about safety and shifting market dynamics.Conclusion This scoping review indicates that deregulation, particularly in regions with limited healthcare access, enhances availability of medications and facilitates self-medication. Risk-based governance relies on safety-based classification, which establishes dispensing restrictions and determines where and how products may be accessed. These safeguards are further supported by controls such as pack-size limitations, mandated personnel qualifications, regulatory oversight, and consumer education to promote safe usage.
Adverse drug reactions (ADRs) represent a significant public health issue, substantially contributing to preventable morbidity, mortality, and healthcare expenditures globally. Pharmacovigilance is important for protecting public health and ensuring safe and effective medicine use, especially in low- and middle-income countries where regulatory systems are still developing. Bangladesh has achieved significant advancements in developing a national pharmacovigilance framework under the Directorate General of Drug Administration (DGDA), which includes the establishment of an Adverse Drug Reaction Monitoring (ADRM) cells, involvement in the World Health Organization Programme for International Drug Monitoring, and the introduction of national pharmacovigilance guidelines. Despite these efforts, Bangladesh's pharmacovigilance system is still in its infancy and faces a number of challenges, such as significant underreporting of ADRs, a lack of awareness and training among healthcare professionals (HCPs), insufficient enforcement of regulations, inadequate technology infrastructure, and weak stakeholder coordination. The commentary will narrate the current status of pharmacovigilance in Bangladesh, identify the key challenges and potential areas for strengthening the system.
Background The excessively high prices of High-Value Medical Consumables (HVMCs) and the substantial financial burden on patients are core issues in China’s healthcare reform. Although the Volume-Based Procurement (VBP) policies have significantly reduced prices, insufficient policy coordination has led to frequent implementation deviations, constraining the effectiveness of reforms.Methods Guided by a three-dimensional framework encompassing policy intensity, measures, and objectives, this study employed an integrated analytical process. Text mining facilitated initial thematic identification, which was then iteratively refined and validated through the Delphi method to establish quantifiable indicators within the framework. These indicators were analysed using a synergy degree model to evaluate policy alignment. 21 national-level policies from 2004 to 2024 are analysed.Results Based on the constructed synergy indices, policy development underwent three stages: ‘initial exploration, gradual development, and stable optimization'. As indicated by the model, the synergy degree showed an evolutionary trend, moving from early dispersion, to mid-term leap, and later differentiation. According to the indices, planning guidance and administrative measures showed relatively high synergy over the long term but appeared to squeeze the synergy space for other measures. The results also indicated that imbalances existed among policy objectives, with contradictions between cost control and innovation goals, and insufficient adaptation between medical insurance payment and industry development. Based on these model-based findings, optimisation strategies such as classified coordination mechanisms, dynamic weight adjustment, and closed-loop feedback for quality and supply are proposed.Conclusion Theoretically, this study is the first to systematically quantify the degree of synergy of high-value medical consumables policies by developing a framework-based coordination analysis model using constructed indices. Practically, it provides a scientific basis for optimising policy combinations, balancing short-term cost control with long-term industrial innovation, and improving medical insurance support mechanisms.
Background:Access to essential medicine is a worldwide issue, driven by high prices, low affordability and limited availability. Under funded health systems, weak local production, poor supply chain governance, and discriminatory policies are the main hurdles. Low and middle-income countries are continuously making efforts to improve healthcare services. To evaluate the extent to which the intended objectives have been met, the present study undertakes an investigation into the pricing, availability, and affordability of selected essential medicines in Pakistan. Methods:A survey of 50 essential medicines, including 14 from the global core list and 36 selected from the national essential medicine list, was carried out from November 2025 to February 2026, using an adaptation of WHO/HAI methodology in five geographical areas of Pakistan. Data were acquired from 9 pharmacies of government hospitals and 18 retail pharmacies of the private sector. Prices were evaluated on the basis of the Median Price Ratio (MPR); affordability was determined by estimating how many days a minimum salaried employee of the government must spend to buy the prescribed regimen. Results:In the public sector mean availability was 12.65% (IB), 36.2% (LPG) and in private sector it was 45.7% (IB) and 55.2% (LPG). In private retail pharmacies, 13.61% were stocked with oncology medicines. Median price ratios in the private sector varied between 0.11-6.85 for LPG and 0.17-23.37 for IB. Median price ratio of 12 medicines (out of 36 calculated for MPR) was approximately similar between LPG and IB. However, prices for cardiovascular and antidiabetic medicines increased. Conclusion:Availability of LPGs has improved in the private sector. Median price ratios have decreased over time, but medicines are still unaffordable, especially for diabetes, viral, fungal and bacterial infectious diseases.
Background:Patients with end-stage renal disease (ESRD) are increased risk of herpes zoster (HZ). The economic value of HZ vaccines in Thai patients with ESRD has not been assessed. This study evaluated the cost-utility and budget impact of two HZ vaccination strategies - zoster vaccine live (ZVL) and recombinant zoster vaccine (RZV) - compared with no vaccination in Thailand. Methods:A Markov model was developed to estimate lifetime health and economic outcomes in patients with ESRD. Cost-utility analysis was conducted from a societal perspective, while budget impact analysis was performed from a payer perspective over a 5-year time horizon. Model inputs were derived from published literature and Thai data sources. Uncertainty was assessed using deterministic, probabilistic, and scenario sensitivity analyses. Results:In the base-case analysis, both ZVL and RZV were cost-effective compared with no vaccination, with incremental cost-effectiveness ratios (ICER) of USD 1,599.14 (THB 51,912.56) and USD 2,920.09 (THB 94,794.30) per quality-adjusted life year (QALY) gained, respectively - both below Thailand's willingness-to-pay threshold. RZV generated greater health benefits but was associated with higher costs. Sensitivity analyses confirmed the robustness of cost-effectiveness results across key assumptions. Over a 5-year period, the estimated budget impact ranged from USD 4.99-9.55 million (THB 161.86-310.02 million) for ZVL and USD 28.92-55.42 million (THB 938.95-1,799.09 million) for RZV, depending on vaccine uptake assumptions, with expenditures largely concentrated in the first year due to vaccination of prevalent patients. Conclusion:Both HZ vaccines are cost-effective options for preventing HZ in Thai patients with ESRD. While RZV provides greater health gains, it requires substantially higher budgetary investment. These findings support prioritising HZ vaccination for patients with ESRD and initiating pilot implementation within dialysis care settings to assess system-level impact and feasibility.
Background:Diabetic peripheral neuropathy (DPN) affects approximately half of individuals with diabetes. Community pharmacists play a pivotal role in the early management of DPN. This exploratory study examined community pharmacist practices in DPN assessment and management, with particular focus on attitudes toward and factors influencing neurotropic B vitamin recommendations. Methods:A cross-sectional survey was conducted among a convenience sample of community pharmacists in Bangkok, Thailand. The questionnaire focused on pharmacists' attitudes and practices in managing patients presenting with negative symptoms, positive symptoms, or diagnosed DPN. Results:Ninety community pharmacists participated in this study. Most patients presented with mild symptoms. Symptom severity was primarily assessed based on patient history and pain scales. Among patients presenting with negative symptoms and overt DPN, the most frequently recommended medication was a combined neurotropic B vitamin (48.11% and 44.73%, respectively). The factor associated with likelihood of recommending combined neurotropic B vitamins was reasonable product price, while guideline recommendation, package labelling, and brand reputation showed inverse association with recommendation behaviour. Conclusion:Community pharmacists frequently recommend neurotropic B vitamins for early-stage and painless DPN - presentations not addressed in current clinical guidelines. The inverse associations between guideline endorsement and recommendation behaviour likely reflect these guideline gaps rather than inappropriate practice. Pharmacy-specific clinical guidelines and clearer product labelling addressing both painful and painless DPN are needed. Given the exploratory design and convenience sampling from Bangkok, findings should be interpreted as hypothesis-generating.
Background:Since the COVID-19 pandemic, uptake of childhood and adolescent vaccines recommended under the National Immunisation Program (NIP) in Australia has declined, while adult NIP vaccine uptake remains stable but suboptimal. Over the past 10 years, pharmacists have taken on a larger role in NIP vaccination, yet their communication and information needs are not well understood. Supportive vaccine conversations are key to improving uptake, but can be difficult, especially with hesitant patients. This study explored Australian pharmacist immunisers' experiences and support needs around vaccine conversations with patients, aiming to inform evidence-based communication resources. Methods:Qualitative interviews from 12 community, 7 aged care and 3 general practice pharmacist immunisers from across metropolitan, regional and rural Australia were analysed thematically. Most participants reported vaccinating adults and older adults. Results:Key themes include: 1. The usual practice; 2. What works well; 3. The gaps and challenges; 4. Addressing the gaps: perspectives and recommendations from pharmacist immunisers. We found that pharmacists - especially in regional areas - are known to the community, offer valued advice and accessible vaccinations. While many reported using effective vaccine communication, they identified a need for further clinical guidance, scenario-based training and tools to address misinformation and emotional concerns. Other needs included tailored support for aged care, accessible vaccine resources for older adults, culturally and linguistically diverse communities, and those with limited literacy and peer forums for rural and sole pharmacists. Conclusion:The study offers insights into practices and information and communication support needs of Australian pharmacist immunisers, especially in underexplored areas like aged care and sole pharmacist rural practice. It highlights the need to better disseminate existing communication supports and develop new ones. Further research should explore sector-specific and systemic challenges, and communication needs with younger populations and their carers.
Background Community pharmacists in France have recently been authorised to dispense antibiotics without a medical prescription for group A streptococcal pharyngitis and uncomplicated acute cystitis, provided that the result of a point-of-care test (POCT) is positive. In this study we aimed to analyse the implementation and adoption of these tests in community pharmacies and their potential impact.Method We elaborated a questionnaire for the pharmacists and one for the patients. The former was distributed through a professional email database and shared on social media. The later was disseminated through social media, directly in pharmacies via a QR code displayed on the counters of participating pharmacies. Qualitative data were analysed thematically.Results A total of 64 pharmacists and 31 patients responded to the questionnaires. Among the patients, 35.5% (n = 11/31) had previously consulted a pharmacist for pharyngitis and/or cystitis before consulting another healthcare professional, and of those, 45.5% (n = 5/11) had undergone a POCT. Conversely, 61.3% (n = 19/31) were unaware of these services. Among pharmacists, 93.8% (n = 60/64) performed at least one of the two POCTs. Throat POCTs were most often initiated by pharmacists (37.5%) and physicians (34.8%), whereas cystitis POCT were mainly initiated by the patients themselves (54.8%). According to pharmacists, the main barrier to implementing POCTs in community pharmacies was lack of time (69.1%; n = 38/55). For 84.7% (n = 50/59) of pharmacists, POCTs are well integrated into the daily workflow, and the implementation of POCT even helped enhance the value of their professional role. Most patients were in favour of expanding the range of pharmacy-based tests.Conclusion The positive adhesion of both pharmacists and patients reinforces the value of these services in promoting appropriate care. Low public awareness remains a barrier, underlying the need for targeted communication strategies.
Background Transfusion-dependent beta-thalassemia requires lifelong treatment, yet economic evidence in adult patients remains limited, particularly for direct non-medical and indirect costs in high-prevalence, middle-income settings. This study aimed to estimate the annual cost-of-illness and health utility, and to examine their associations with clinical and sociodemographic factors among Thai adults with transfusion-dependent beta-thalassemia. Methods Adult patients with beta-thalassemia major or beta-thalassemia/hemoglobin E disease receiving regular transfusions at two university-affiliated tertiary hospitals in Thailand were enrolled. Sociodemographic data, health utility (EQ-5D-5L), and productivity losses (Work Productivity and Activity Impairment questionnaire) were collected via structured interviews. Healthcare resource utilisation over the preceding 12 months was obtained from hospital records. Costs were annualised and analyzed from a societal perspective. Generalised linear models were used to identify predictors of costs and health utility. Results Eighty-two patients were included. The mean total annual societal cost was $5,093 (95% CI: $4,467-$5,926) per patient. Patients with medium-to-high transfusion burden incurred significantly higher median costs than those with low transfusion burden ($5,260 vs. $3,841; p = 0.020). Direct medical costs were the primary cost driver (60%), largely attributable to outpatient visits, blood transfusions, and iron chelation therapy, followed by indirect costs (26%), with productivity losses driven mainly by presenteeism. Blood transfusion intensity and iron chelation therapy use were significant determinants of total costs (p < 0.05), providing actionable parameters for budget impact forecasting. Mean health utility was 0.912 (95% CI: 0.890-0.934), yet differences across insurance schemes suggested potential inequities in access to optimal care. Conclusion Adult transfusion-dependent beta-thalassemia imposes a substantial economic burden in Thailand, driven largely by direct medical costs. Identification of key cost drivers provides relevant evidence to inform healthcare planning, resource allocation, and policy efforts to address care inequities in high-prevalence settings.
Background:This study aimed to examine the methodological quality of measurement properties of health literacy instruments used in children, specifically in Asian countries, and to identify the most suitable instrument for field application. Methods:This systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Health literacy studies conducted between 2013 and 2023 and involving children aged 6-18 years old were identified through searches in PubMed, Scopus and Web of Science. Only studies that assessed methodological qualities were included. Quality appraisal was conducted using COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN). Result:A total of 10 studies met the inclusion criteria from the screening process. The quality of measurement properties in these studies varied. With 9 items on the COSMIN checklist and 10 studies assessed, this resulted in a total of 90 checklist items evaluated. Based on this, 25 items were classified as very good (primarily for structural validity and general criteria), 7 as adequate (mainly for content validity), 14 as inadequate (mostly for internal consistency), 10 as doubtful (mostly for reliability) and 34 as unknown (primarily for measurement error, cross-cultural validity and responsiveness). Nearly 40% (37.7%) of measurement quality ratings were either unknown or not reported. Among the tools assessed, the 8-item Health Literacy Assessment Tool Chinese version (C-HLAT-8) demonstrated very good quality across most measurement properties compared to others. C-HLAT-8 includes functional, interactive and critical health literacy domains and has been assessed in children aged 11-17 in China. Conclusion:Despite the global interest in health literacy, studies focusing on methodological quality in the context of school children and Asian countries remain limited. The C-HLAT 8 emerges as a promising tool for field application due to its strong methodological quality and adaptability.
Background In numerous low- and middle-income countries (LMICs), good manufacturing practice (GMP) compliance frameworks ostensibly mirror those of stringent regulatory authorities (SRAs). In practice, limited enforcement capacity and corruption-susceptible inspection systems render facility certificates unreliable indicators of quality.Objective This conceptual policy design article proposes a tier-based, product-centric compliance platform intended to deliver measurable patient protection under constrained regulatory capacity, incorporating falsification-resistant evidence requirements and anti-corruption design features benchmarked against the FDA, EU, PIC/S, and WHO Prequalification Program frameworks.Approach The article is positioned as a conceptual policy design framework rooted in structured comparative regulatory analysis, rather than a systematic review or empirical evaluation. It draws on enforceable regulations, ICH guidelines, FDA and EU guidance, PIC/S inspection standards, WHO and WHO/UNODC reports, WHO Global Surveillance and Monitoring System (GSMS) data, and peer-reviewed evidence on substandard and falsified (SF) medicines. Sources were purposively selected, favouring enforceable regulation, documented clinical or mortality outcomes, and official reports from organisations with direct regulatory authority.Results The platform functions through three consecutive tiers. Tier 1 mandates verification of raw material and excipient equivalence as a prerequisite for market eligibility ($500 to $2,000 per product dossier). Tier 2 implements recorded remote regulatory assessments (recorded RRAs) aligned with the FDA's RRA framework and PIC/S practices, incorporating engineered anti-staging and anti-falsification countermeasures. Tier 3 allocates risk-based onsite inspections for high-risk operations and escalation triggers. A minimum viable product (MVP) configuration is delineated for regulators unable to implement the full platform immediately, limiting Tier 1 to critical excipients with a documented history of mass-casualty incidents, and Tier 2 to pediatric oral liquids and sterile injectables, at approximately 30 to 40 per cent of the total platform cost. An analysis of political economy and stakeholder incentives identifies resistance scenarios at the inspector, manufacturer, procurement agency, and regulator levels, each paired with embedded mitigation strategies. A pre-registered, stepped-wedge pilot evaluation framework is proposed, featuring predefined effect-size thresholds and a non-equivalent control series.Conclusion A product-centric, evidence-linked compliance platform offers a viable pathway toward measurable patient protection in corruption-exposed environments, provided feasibility constraints, political economy barriers, and equity considerations are addressed during implementation design. Future efforts should prioritise pilot studies, cost-effectiveness modelling, and structured stakeholder consultation.
Background:The COVID-19 pandemic caused significant disruptions in oncology services worldwide. Breast cancer care depends on timely and coordinated treatment pathways. This review assessed changes in systemic anti-cancer therapy, including chemotherapy, endocrine therapy, targeted therapy, and immunotherapy. Secondary outcomes included treatment delays, short-term mortality, and hospital admissions. Methods:We conducted a systematic review and meta-analysis following PRISMA guidelines. The protocol was registered with PROSPERO (CRD42024542702). We searched PubMed, Scopus, Web of Science, and CINAHL for studies published between March 2020 and August 2024. We included original studies comparing adult breast cancer patients treated before and during the pandemic. Patients of any stage and sex were eligible. We assessed risk of bias and used a random-effects model to present pooled proportions and odds ratios (ORs) with 95% confidence intervals (CIs). Results:Forty-eight studies were included in the review, and 35 in the meta-analysis. Chemotherapy use increased from 35% before the pandemic to 42% during the pandemic. This rise was driven by an increase in neoadjuvant chemotherapy, from 18% to 22%, while adjuvant chemotherapy remained stable. Endocrine therapy increased from 35% to 42%. Neoadjuvant endocrine therapy rose from 2% to 10%, whereas adjuvant endocrine therapy declined from 46% to 43%. Targeted therapy and immunotherapy showed minimal change. The pooled OR for short-term mortality was 0.81 (95% CI: 0.56-1.15). Hospital admission estimates showed wide confidence intervals, reflecting heterogeneity. Conclusion:The pandemic led to notable shifts in systemic treatment patterns, particularly an increase in the use of neoadjuvant strategies. Short-term mortality did not significantly differ between periods. The study findings should be interpreted with caution due to variability in studies. Health systems require robust pharmaceutical policies and resilient triage frameworks to ensure continuity of cancer treatment during future crises.
Background:Patient satisfaction is a key indicator of healthcare quality and a driver of medication adherence and trust in community pharmacy practice. However, validated instruments that specifically assess patients' satisfaction with community pharmacists and pharmacies remain scarce. This study aimed to develop and validate the 9-item Patient Satisfaction Questionnaire (PSQ-9), a concise tool tailored to community pharmacy settings, and to identify factors associated with patient satisfaction. Methods:A cross-sectional online survey of 501 adults from all Lebanese districts was conducted between February and May 2025. The PSQ-9 was derived from the modified 18-item PSQ using exploratory (EFA) and confirmatory (CFA) factor analyses on two independent subsamples. Psychometric testing included internal consistency, test-retest reliability, construct validity, and multigroup CFA to assess measurement invariance. Multivariable linear regression identified correlates of satisfaction. Results:The PSQ-9 demonstrated a two-factor structure, Interpersonal Care and Professional Engagement and Affordability and Informational Assurance, with excellent model fit (CFI = 0.984, RMSEA = 0.056, SRMR = 0.027) and reliability (α = 0.904, ω = 0.910, ICC = 0.729). Measurement invariance was established across gender, health status, and access to care. Higher satisfaction was associated with easier access to healthcare (B = 1.470, P = 0.012), pharmacist counselling from time to time (B = 1.616, P = 0.004) or regularly (B = 1.864, P = 0.008), longer counselling (>10 min; B = 2.441, P = 0.004), higher patient expectations (B = 0.356, P = 0.001) and perceptions (B = 0.110, P = 0.002), and fewer communication barriers (B = -0.235, P = 0.005). Conclusion:The PSQ-9 is a valid, reliable, and contextually adapted instrument for assessing patient satisfaction with community pharmacy services. Its brevity and psychometric robustness make it ideal for large-scale surveys and benchmarking, supporting patient-centered and equitable pharmacy practice improvement.
Background:Acceptability and sustained engagement of mobile health (mHealth) applications in resource-limited settings for chronic disease management are suboptimal. Research on mHealth applications overlooks contextual factors affecting the translation of their acceptance to long-term usage. Methods:This study examined contextual factors using questionnaire developed by Technological Acceptance Models (TAM) and Expectation Confirmation Theory (ECT), to study the influence of technology acceptance (TA) on Sustained App-based Engagement and Use (ABEU) among Type 2 Diabetes Mellitus (T2DM) patients. Data were collected through purposive sampling from 397 T2DM patients across public and private hospitals in four provinces of Pakistan. Exploratory factor analysis, confirmatory factor analysis, and structural equation modelling validated hypothesised relationships. Results:Model depicted a strong, positive effect of TA on ABEU (β = 0.65, p < 0.001), indicating acceptance led to sustained use of mHealth. Based on β ≥ 0.50 for acceptance and engagement, Social image boost, Confidence boost, Better health through app use, and Doctors' recommendations were important cultural factors. Satisfaction, Better sugar levels, Confidence in App use, Search and download ability, and Easy access to reliable information were critical contextual factors. Better health facilities, Time-saving, and Internet speed and connectivity were key infrastructural factors. Improved health facilities, faster internet speeds, and reliable connectivity were boosted through users' confidence and enhanced self-image, encouraging them to engage, supported by increased satisfaction and perceived health benefits. Conclusion:TA significantly impacted ABEU through contextual, cultural and infrastructural factors in mHealth adoption, underscoring the need for actionable insights to improve mHealth adoption and retention.
Background:Integrating social media into healthcare practice presents opportunities and poses key challenges for health professionals. While multiple reviews have been published, Western contexts receive the most attention, despite the distinct cultural and regulatory contexts that may shape social media use in other regions. The aim of this review was to scope the views and experiences of health professionals in the Middle East and North Africa region regarding social media use. Methods:Six databases were systematically searched from inception to November 2022 (updated search in March 2025). Studies published in English reporting the views and experiences of health professionals regarding social media use in 24 MENA countries were included. Two reviewers independently screened articles for selection, followed by data extraction and synthesis. Results:Thirty-eight studies were included; the majority adopted cross-sectional methodology (n = 36), with physicians the most studied group (n = 18) and mostly from Saudi Arabia (n = 22). Only two studies included theory in the development of data collection tools. Positive and negative views and experiences were reported along with the need for education and policies and guidance. Positive themes related to aspects of knowledge and skills, networking, patient communication, marketing, and perceptions of improved practice and enhanced patient care. Negative themes were less well reported and focused on data protection, social media being a distraction, and the perceived impact on well-being. Conclusions:Despite the substantial volume of existing studies, the evidence remains largely descriptive and lacking in theoretical grounding. More rigorous, in-depth research encompassing all health professional groups is needed to clarify the mechanisms through which social media influences practice. Such work is essential for informing robust policies, practical guidelines, and targeted educational strategies that can mitigate risks while maximising the professional and clinical benefits of social media use.
Background:Effective procurement is crucial for securing affordable medicines, yet limited evidence exists on pricing influences in Malaysia's dynamic pharmaceutical market. This study analysed factors associated with purchased price variation, bidder price dispersion, and higher-tier drug prices within the Ministry of Health's (MOH) segmented procurement system, focusing on market competition dynamics. Methods:A retrospective analysis was conducted on eight high-expenditure therapeutic subgroups (2017-2021) using data from 19 MOH facilities across five regions. Price variation was calculated as the ratio of observed to minimum brand price, and bidder dispersion as the ratio of highest to lowest quoted price. Higher-tier prices exceeded the median price for a given brand. The Kruskal-Wallis H test was applied to examine distributional differences in purchased drug prices and bidder-quoted prices across categorical variables, while logistic regression was used to identify factors associated with higher-tier pricing (p < 0.05). Factors analysed included geographical zones, facility types, procurement values, therapeutic subgroups, purchased product types, dosage forms and the number of competing agents and products. Results:Among 97 drugs from 4,702 purchase records involving 28 suppliers, East Malaysia showed significantly higher price variation, and all regions had greater odds of higher-tier pricing than the Central region (p < 0.05). Lower procurement values were linked to greater price variation and higher-tier pricing (p < 0.05). Imported generics exhibited higher price variation (p < 0.001) but lower prices than innovators and local generics. Procurements with ≥3 competing agents had lower price variation (p < 0.008) but greater bidder dispersion (p < 0.001), while up to five agents increased the likelihood of higher-tier pricing (p < 0.05) compared to 7-12 agents. Conclusion:Findings highlight that both market and non-price competition influence procurement efficiency and price stability.
