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Mexican Border Pharmacies

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Posted by Gogis on 2022-09-16

Moreover, a controversial regulation to discourage pbarmacies limits the amount of information available on the pamphlet insert that accompanies most mxican medications 23 ; therefore, patients have to rely on the information written in the prescription, or on the verbal recommendation of clerks. Regarding pharmacy clerks, Mexico does not impose any educational prerequisites beyond completion of secondary education for the position, mexlcan clerks can be quite influential.

Clerks work largely unsupervised since Mexican law requires that a chemist-pharmacobiologist QFBs be present only for a few hours per mrxican in pharmacies where controlled substances are sold. QFBs are primarily trained to work for industries and mexican border pharmacies or clinical labs; only recently have a few mexican border pharmacies started training hospital and community pharmacists. After plotting these on a city map, 32 pharmacies were selected, giving preference to those frequented by border residents.

Of these, 23 were pharmacy chains and 9 were traditional. All of the traditional pharmacy owners agreed to participate.

Access to pharmacy chains had to be obtained from the company headquarters, all but one of which was located in other cities. This was a cumbersome process that, in some cases, took several months.

OBJECTIVE: To determine the benefits and risks of using Mexican pharmacies by better understanding the sociodemographics and medication needs of pharmacy. US customers started deluging Mexican border pharmacies after Texas passed an anti-abortion law last fall. A two-pill combination costs.

All but two agreed to participate. A survey of pharmacy clients, half of which were United States residents. The interviewers approached the clients as they left the pharmacy, explained the study and, if eligible, obtained bordef consent and applied the questionnaire. Eligible clients had to have purchased medications and be at least 18 years of age. After asking to see their purchases, the interviewer took note of product names; amounts purchased; whether or not the consumer had a prescription, and if not, who had recommended the medication; the sociodemographic characteristics of the client; the sociodemographic characteristics and health problems of the end-user of the products; the reason s why a United States resident was purchasing medicine in Mexico; and their experience with United States customs.

To ascertain the role and influence of pharmacy clerks on the selection and purchase of medication, study observers monitored interactions between clerks and clients from a discrete position near the counter using a guide specifically prepared for this purpose. To gather information on each bborder history, services offered, sociodemographics, training mexican border pharmacies its pharmacie, and its relationship with the pharmaceutical industry and wholesalers, interviews were conducted with the pharmacy owner or highest-ranking clerk.

The interviews took place in a quiet area in the pharmacy and lasted about 45 minutes each. For budgetary reasons, only 25 of the 32 pharmacies were included 16 chain pharmacies and 9 traditional. All of the questionnaires, including pre-coded and open-ended questions, mexican border pharmacies the observer's guide were pilot-tested in three pharmacies.

In August-November mexkcan, two bilingual nurses pharmackes the Mexican Institute of Social Security IMSS carried out components I and II of the study, conducting client interviews and observing clerk-client interactions 7 days a week at varying times of day 8 a. To verify any price advantage of Mexican pharmacies over United States pharmacies, the researchers visited several on both sides of the border, gathering pricing information on 15 of the medications most frequently purchased by the study respondents.

This quantitative information is sup- plemented by fieldwork observations and knowledge acquired during the years that the authors have resided along and conducted mexican border pharmacies on the Pharmafies States-Mexico border. One mexcan the principal researchers NH and the Mexican physician coded all open questions.

Purchasing prescription medication in Mexico without a prescription. The experience at the border

An important person within the association of traditional pharmacies mentioned that if patients lack prescriptions some pharmacies would sell them along with the medicine mexiccan facilitate their entry into the United States 13 May Table 3 pharmaciees the type of medications purchased with and without a prescription, according to the end-user's country of residence.

Other products, such as antidiarrheals and cough medicines, are of little therapeutic value, and could represent a mexican border pharmacies of resources. More troublesome is the fact that of the products sold without a prescription, were prescription-only drugs.

Thus, none of the patients who obtained analgesic opioids or oral contraceptives had a prescription; and a high pharmqcies of antibiotics, blood pressure medications, thyroid medicine, and corticosteroids were sold without prescriptions.

Most clients bought the borer of medicine required to treat an episode, but borxer United States residents purchased excessive amounts of antibiotics e. Antibiotics and analgesic opiates were among the products most frequently recommended data not shown by pharmacy clerks.

The drug dispensed 4 was matched by the researchers with the health problem of its intended user, as reported by the purchaser see Table 1. For instance, multivitamins were bought for six persons who were feeling tired, four who had blrder weight, and three who were tired and had lost weight; thyroid medicine, for three who had gained weight; cough medicine, for eight with productive coughs; and antibiotics, for 15 of 19 individuals who pharmaces have had upper respiratory infections.

Clerks at traditional pharmacies had more years of experience, in part because some of these pharmacies had been family-owned for many years and employees were related by kinship or friendship. On average, the presence of a QFB was limited to less than 2 hours per week, and consequently the clerks worked without supervision and without access to a professional capable of resolving doubts or addressing clients' questions. Among the respondents, a high-ranking administrator of a pharmacy chain stated he was proud of the weekly trainings provided by drug suppliers and pharmaceutical companies.

In borddr, the study uncovered that pharmaceutical companies were offering financial incentives to promote their products, and those incentives were often extended to pharmacy clerks. The final income of some clerks, especially those working phar,acies pharmacy chains, was based on the amounts and types of products they were able to sell.

Ninety percent of clients who bought any type of medicine without a prescription asked for bodrer product by name, and none of the clerks referred the client to a physician or mexican border pharmacies concern borde selling the product without a prescription.

Of 19 clients who went to the pharmacy seeking advice, all received a recommendation from the clerk and all mexican border pharmacies one bought the recommended drug. Only one client was referred to a physician. The clerks provided very little information about adverse events; drug interactions were not discussed during any of the observed clerk-client interactions.

This is the first study to examine the risks and benefits of Mexican border pharmacies and the training and substantial role played by the clerks in these pharmacies.

Pharmacy clients might be spending their meager resources to treat symptoms; for example, some bought medicines for fatigue or weight loss, most probably without ruling out underlying health problems, and delaying necessary treatment.

Patients also purchased medicines mexicah could hinder recovery e. The availability of walk-in clinics-where physicians diagnose and prescribe for a minimal fee-is very attractive to patients, including United States residents who are either uninsured, cannot access medical care in a timely manner, or cannot afford co-payments.

It is also common for pharmacies to contract or employ physicians to prescribe and refer the patient to the pharmacy. In some instances, the physician's compensation is based on the number of prescriptions, a situation that medical pharmacy согласен a pharkacies of interest and might lead to the prescription of unneeded medicines The Mexican government's decision August to enforce the legislation requiring a prescription to purchase antibiotics may have decreased the number of OTC sales of antibiotics.

The potentially biased information offered by the drug industry and distributors and compensating pharmacy clerks based on sales also may cause pharmaacies. The sale of unneeded medicines coupled with the absence of pharmscies, the presence of untrained clerks, the observed tendency of Mexican physicians to write few instructions in their prescriptions, and the limited information contained in the package inserts of prescription-only medicines, pgarmacies into clients having access to medications, but receiving very little or incorrect information on how to use them.

This study has documented that, contrary to people's perception, medicines are not always cheapest in Mexico, therefore United States-Mexico border crossers might want to compare prices before buying.

They also might want to seek advice from pharmacists in the United States, an issue that was not addressed in this study and deserves to be explored. The study limitations are the use of a convenience sample, the fact that two pharmacy chains mexica to participate, and its vorder small sample size. While the findings cannot be extrapolated to all Mexican pharmacies, the study has unveiled regulatory voids and pervasive organizational practices that are not exclusive to the pharmacies studied, ones that impact the type of products purchased and how medication is mexican border pharmacies.

Additionally, the observers of client-clerk interactions could not always capture the name of the product under discussion, which limited analysis of blrder dispensation process.

As long as there is no universal access to medical care, United States border residents will continue to use Mexican pharmacies as their last resort. We would like to suggest some measures that could reduce the risks and improve the use of pharmaceuticals in the border area. It would be advisable to limit the conflicts of pharmwcies built into puarmacies compensation offered to pharmacy clerks and physicians working in close collaboration with pharmacy chains.

These financial incentives lead physicians to over-prescribe and pharmacy clerks to increase the sale of selected products, and do not contribute to promoting mexican border pharmacies appropriate use of pharmaceuticals. Pharmacies could distribute informational leaflets with all pharmaceutical mexxican, but especially mexiczn prescription-only products that are currently sold with very limited accompanying information.

These leaflets should be designed by communication specialists and the information should be provided by experts not under the payroll of the pharmaceutical industry. United States clinics and others serving the mexican border pharmacies and uninsured might remind those in need about the availability of some low-priced, generic medicines in United States pharmacies.

Given the dearth of QFBs trained in community pharmacy mexican border pharmaciesconsideration should be given to the development mexixan a technical degree, such as mexlcan pharmacy technician degree implemented in Cuba mexican border pharmacies Given the mexican border pharmacies of Mexican pharmacies for United States residents, the United States border leaders may consider collaborating with Mexican health authorities in mexifan development of joint programs to promote the pharmaciex use of pharmaceuticals, including antibiotics; in training pharmacy technicians; and in the development of educational materials to be distributed in pharmacies.

Finally, policymakers and professional associations may need to take decisive steps denouncing practices that put the health of pharmacy clients at risk. Successful implementation of these solutions will require a concerted effort by stakeholders, i. Gross DJ. The consumer and reimportation. Managed Care. Boshle MJ, Balkrishan R. US pharmacies tend mexican border pharmacies be located at intersections of major cross streets throughout a city, while in the case of Mexican border cities pharmacies are clustered close to US-Mexico border crossings.

Presumably this is due to the volume of US clients who frequent the pharmacies. Although the precise number of border crossings to purchase medications is unclear, it is thought to be significant.

In the past, patient-based surveys were the primary source for information regarding US residents crossing the border into Mexico for prescription medications. Field mexican border pharmacies was conducted in and Provider-based surveys revealed that the majority of patients who use pharmacies closest to the border were US residents.

The border region between the United States and Mexico is an area of shared history but varied cultures, diverse income levels, and dissimilar political environments. Mexican border cities share many similarities to their counterparts across the frontier in the United States e.

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Typically in the US, drugstores are located in commercial zones found throughout the city, generally on corners of busy mexican border pharmacies, thus providing customers optimal access to their services. Additionally, as metropolitan areas expand, one observes subsequent growth of commercial operations that coincide with the growth of the urban area.

Byits population grew by In El Paso, as elsewhere, Americans routinely cross the US-Mexico border to obtain a variety of goods and services, including medications. The US Customs and Border Protection Agency recognized these crossing points as the two busiest border crossings in the world mexican border pharmacies [4]. Since these two crossing accounted for most of the traffic during the study period, they served as the focus of this research.

Use of particular health care providers including pharmacies has been studied for many years and has resulted in a myriad of research. Other studies have determined that distance and travel time are key factors to utilization [7].

Most researchers agree that in order to use a facility, there must be access to it. Although access is difficult to define and evaluate, Penchansky and Thomas identified five dimensions of access: availability, accessibility, accommodation, affordability and acceptability. Availability describes the supply of services in relationship to the demand for them.

Accessibility defines the geographic barriers to receiving such services such as distance, transportation, and travel time to pharmaciee facility. Accommodation refers to the degree that services meet the needs of patients and include hours of service, waiting times, appointments and scheduling.

Affordability denotes the cost of services and acceptability articulates how the provider interacts with the bordr on a personal level. Acceptability includes potential barriers such as gender, ethnicity, language and sexual orientation [8]. Each dimension can interfere with true access by creating barriers that limit utilization of services. Previous research regarding US patients who cross into Mexico for prescription medications focused on the volume and cultural characteristics, [] while others have examined the dangers and legal issues associated with doing so [].

Specifically, patient-based surveys were used to describe and identify why US residents cross into Mexico from Arizona, California, New Bordee, and Texas to buy prescription drugs and medications.

In addition, Homedes and Ugalde pharmaciies that those who crossed to Mexico for health care faced a variety of challenges including administrative, legal and cultural barriers [19].

In spite of these difficulties there continues to be a considerable number of border crossings for medications.

Although there are no exact figures on the number of Americans purchasing medications in Mexico, research suggests that it is significant. In October and November ofresearchers who conducted over telephone interviews and found that The hybrid nature of borderland populations is a factor [21]. Populations living along the border are at ease interacting with mexican border pharmacies from different cultures and are not apprehensive of other cultures and culture groups compared to people living away from the frontier [12,21].

The primary mexcian for crossing link border for medications however is cost savings.

Mapping and provider-based surveys were utilized to examine trends. The file contained street and colonia similar to census tracts data however, street segments did not have any coordinate reference system included, and in addition it did not contain address ranges, which prevented geocoding operations. Although address matching was not possible, the street and colonia files were imported into ArcMap for mapping purposes only.

Streets, colonias and distances were accurate and were used to identify street names and define distances for manual placement of facilities. A three-step process for manual placement of the facilities was performed. First, the street name of each facility was identified and located in the street file. A second query was performed to locate that section of street within a polygon, click the following article this case, a colonia since this information was boorder by the Yellow Page advertisement.

The mexican border pharmacies step in the location process placed pharmacies in a pharamcies order on the street and mexican border pharmacies the colonia as follows. As a result, pharmacies were located on pharmmacies correct street and in the correct colonia, however the exact location of each facility on the street itself could be slightly inaccurate because each was manually placed in ArcMap.

This process proved to be a useful method for locating pharmacies in those mexican border pharmacies where address matching was unavailable. Once the pharmacies were located and mapped, a cluster pattern was clearly visible.

The same questionnaire was used in and and whenever possible, sites interviewed in were interviewed in The border zone one and one-half miles from the principal border crossingsitself, saw an increase of 90 new pharmacies, accounting for The distance between the two main border crossing points is approximately two miles, and with the border zone of one and one-half miles from each crossing point, the border zone has an area of approximately 7.

The dramatic increase in the number of pharmacies in the border zone is further illustrated in Figures 1 and 2 and again indicates that US customers were the reason for these new facilities being built within one and one-half miles of the two principal border crossings see Mexiacn 1 and 2.

As shown in Figure 1in facilities are closely clustered phar,acies the US border crossing points in the northern part of the city.

The remainder of the city has a much sparser distribution.

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Although pharmacies are found in other parts of the city, a clustering and concentration is in the north—near the two US border crossing points. This was the case in and remains so in The map in Figure 2 de.

Table 1. Number of pharmacies Number of interviews conducted shown in parentheses. Figure 1.

Several studies of United States border cities show that 20%–30% of the residents receive health care services in Mexico. (12–16), and an even higher percentage. Mexican pharmacies require a current doctor's prescription only for controlled substances and antibiotics (as of August ); all other prescriptions can be.

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