Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.A ppraisal of evaluative research used in evidence-based health care centres on three major questions. Firstly, is the research good enough to support a decision on whether or not to implement an intervention? Secondly, what are the research outcomes? Thirdly, is the research transferable to the potential recipients of the intervention (individuals or populations)? 1In this paper we ask whether (or to what extent) evaluative research on public health interventions can be adequately appraised by applying well established criteria for appraising evidence about prevention and treatment in clinical practice. 2-5We adduce that these criteria are very useful in evaluating some important aspects of evidence. However, there are other important aspects of evidence relevant to public health interventions that are not covered by the established criteria. We draw attention to these additional aspects of evidence and explain their importance in the assessment of public health interventions. We emphasise the distinction between the appraisal of evidence and the process of making policy or operational decisions on the implementation of interventions. Research-based evidence is only one of several factors to be taken into account in these decisions.Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the relative success or failure of the intervention itself. Moreover, if an intervention is unsucc...

ObjectiveTo determine the economic impact of medication non-adherence across multiple disease groups.DesignSystematic review.Evidence reviewA comprehensive literature search was conducted in PubMed and Scopus in September 2017. Studies quantifying the cost of medication non-adherence in relation to economic impact were included. Relevant information was extracted and quality assessed using the Drummond checklist.ResultsSeventy-nine individual studies assessing the cost of medication non-adherence across 14 disease groups were included. Wide-scoping cost variations were reported, with lower levels of adherence generally associated with higher total costs. The annual adjusted disease-specific economic cost of non-adherence per person ranged from $949 to $44 190 (in 2015 US$). Costs attributed to ‘all causes’ non-adherence ranged from $5271 to $52 341. Medication possession ratio was the metric most used to calculate patient adherence, with varying cut-off points defining non-adherence. The main indicators used to measure the cost of non-adherence were total cost or total healthcare cost (83% of studies), pharmacy costs (70%), inpatient costs (46%), outpatient costs (50%), emergency department visit costs (27%), medical costs (29%) and hospitalisation costs (18%). Drummond quality assessment yielded 10 studies of high quality with all studies performing partial economic evaluations to varying extents.ConclusionMedication non-adherence places a significant cost burden on healthcare systems. Current research assessing the economic impact of medication non-adherence is limited and of varying quality, failing to provide adaptable data to influence health policy. The correlation between increased non-adherence and higher disease prevalence should be used to inform policymakers to help circumvent avoidable costs to the healthcare system. Differences in methods make the comparison among studies challenging and an accurate estimation of true magnitude of the cost impossible. Standardisation of the metric measures used to estimate medication non-adherence and development of a streamlined approach to quantify costs is required.PROSPERO registration numberCRD42015027338.

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This article describes the evolution of community pharmacy in the Australian health system, and assesses its current and potential future contribution to health care. A central theme is the unique extent and accessibility of community pharmacy to the public, with a vast and dispersed infrastructure that is funded by private enterprise. The viability of community pharmacy as a retail trade depends on a diversification of its service roles and retention of its product-supply roles. Initiatives by the pharmacy profession, the pharmacy industry and the Australian Government are likely to give community pharmacy an increasingly prominent place in health promotion and primary, secondary and tertiary prevention, especially in relation to the management of chronic diseases.

For the three cohorts studied, rural clinical training through extended placements in rural clinical schools had a stronger association than rural background with a preference for, and acceptance of, rural internship.