No abstract

The purpose of this study was to compare the epidemiology of musculoskeletal injuries and workplace ergonomics among rural-based sonographers compared to urban-based sonographers. The authors also tested the use of a biomechanical software program to assess load on the spine and upper extremity joints. A mail-in survey was sent to all practicing sonographers in rural Manitoba, and on-site video-taped ergonomic and biomechanical evaluations were completed for four sites. Rural-based sonographers appear to have greater work stress related to waiting lists, use of outdated and non-adjustable equipment, and high client load. They also do not advocate for better working conditions because they are few in number and geographically distant from one another. Use of the biomechanical software proved minimally useful. Information related to industry standards and greater collaboration is needed to promote workplace health for sonographers.

This tool provides a validated outcome measure for research examining the social aspects of workplace disability. It can also serve as a quality management tool for human resource professionals engaged in continuous improvement of disability management programs.

Pharmaceutical policy makers are increasingly negotiating reimbursement contracts that include confidential price terms that may be affected by drug utilization volumes, patterns, or outcomes. Though such contracts may offer a variety of benefits, including the ability to tie payment to the actual performance of a product, they may also create potential policy challenges. Through telephone interviews about this type of contract, we studied the views of officials in nine of ten Canadian provinces. Use of reimbursement contracts involving confidential discounts is new in Canada and ideas about power and equity emerged as cross-cutting themes in our interviews. Though confidential rebates can lower prices and thereby increase coverage of new medicines, several policy makers felt they had little power in the decision to negotiate rebates. Study participants explained that the recent rise in the use of rebates had been driven by manufacturers' pricing tactics and precedent set by other jurisdictions. Several policy makers expressed concerns that confidential rebates could result in inter-jurisdictional inequities in drug pricing and coverage. Policy makers also noted un-insured and under-insured patients must pay inflated "list prices" even if rebates are negotiated by drug plans. The establishment of policies for disciplined negotiations, inter-jurisdictional cooperation, and provision of drug coverage for all citizens are potential solutions to the challenges created by this new pharmaceutical pricing paradigm.

Background: Product listing agreements (PLAs) between drug manufacturers and drug plans are increasingly common worldwide. Use of PLAs by Canadian provinces has not previously been documented. Methods: We collected data from all provinces on funding and PLA use for 25 drugs that were reviewed by the Common Drug Review (CDR) in 2010 or 2011 and funded by at least one province as of May 2012. We measured correlations between coverage and PLA use, and CDR recommendations and PLA use. Results: The number of drugs from our sample funded by provinces ranged from three in Prince Edward Island to 21 in Ontario. PLA use ranged from zero in Quebec, Prince Edward Island, and Newfoundland and Labrador to 20 in Ontario. The correlation between drugs funded and PLAs used by each province was statistically significant (r=0.57, p=0.04); excluding Ontario, however, the correlation was not significant (r=0.10, p=0.40). There was a stronger correlation between the number of provinces funding a drug and the number using PLAs among the subset of drugs with negative CDR recommendations (r=0.87, p<0.01) versus those with positive recommendations (r=0.52, p=0.03). Of the 12 drugs sampled with a negative CDR recommendation, 10 were funded with a PLA in at least one province. Interpretation: There is wide interprovincial variation in PLA use and evidence that PLAs may be used to fund drugs that are not otherwise cost-effective. If global pricing strategies are making PLAs necessary, Canadian governments should collaborate to improve the equity, transparency and effectiveness of PLAs across provinces.