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What we know: Clinic-based policies are effective for reducing interactions between physicians and pharmaceutical companies in terms of free samples, promotional material, and meeting with pharmaceutical industry representatives. Alkhaled et al., 2014 reported that a US-based study found that prescriptions of first-line medications rose from 38% from 61% (OR 2.73, 95% CI 1.29 to 5.76) after six months of implementing a clinic-based policy that prohibited pharmaceutical samples distribution.
Further description: Identified practices associated with restricting access included refusing promotional material and appointments for representatives, preventing representatives from accessing sample cupboards, and only allowing physicians to see representatives outside of consulting hours.
What we know: Clinic-based policies are effective for reducing interactions between physicians and pharmaceutical companies in terms of free samples, promotional material, and meeting with pharmaceutical industry representatives (Alkhaled et al., 2014).
Examples of implementation: A clinic-based policy implemented at Inala Health Centre general practice in Brisbane (Australia) was associated with reductions in overall promotional material (32% at 3 months, 21% at 9 months), reductions in number of samples (59% at 3 months and 70% at 9 months), fewer prescriptions per patient encounter (0.99 pre-intervention to 0.92 and 0.54 at 3 and 9 months post-intervention) and an increase in generic prescriptions (4% pre-intervention to 8.6% and 9.1% after 3 and 9 months of the intervention) (see Spurling and Mansfield 2007 in Alkhaled et al., 2014). A similar policy was implemented at Madras Medical Group family practice clinics in Ohio (USA), which led to an overall decrease in use of 'promoted agents' (1.4%) and increase of 'non-promoted branded agents' (3.0%) after 18 months of implementation (see Hartung et al., 2010 in Alkhaled et al., 2014).
Further description: This collaborative approach between the pharmaceutical industry and a local health authority (Warwickshire, UK). The approach involved post-graduate educational allowance accreditation and a letter from the pharmaceutical advisor asking the practice to meet with a representative (see Freemantle et al., 2000 in Alkhaled et al., 2014).
What we know: A randomised control trial (see Freemantle et al., 2000 in Alkhaled et al., 2014) evaluated whether this collaborative approach within a primary care context would be effective for substituting a proton inhibitor for an alternative deemed therapeutically equivalent but less costly based on 'evidence-based guidelines'. Both control and experimental groups moved toward the recommended guidelines but the proportion of prescriptions and overall costs were similar between the groups, indicating the intervention had no effect.
Examples of implementation: Sunshine (Act) Laws within the United States - The Sunshine Act (est. 2010) aimed to regulate the financial disclosure of payments between healthcare providers and pharmaceutical companies (including manufacturers of drugs, medical devices and biologicals in US federal health care programmes). The act requires the reporting of certain payments and items of value from pharmaceutical companies to physicians and teaching hospitals (e.g., fees for speaking and consultations, free food), as a means of preventing undue influence and protecting public interest (Alkhaled et al., 2014).
Types of identified practices: Public subsidies; deposit refund systems; disposal/tipping fees; product charges; user charges for municipal solid waste (MSW) collection and disposal (e.g., flat rate per container or weight; adjustable rates for predefined weight ranges; fixed pricing with flat and variable rates).
What we know: In general, use of regulation and economic incentives are effective for promoting MSW management, but the effectiveness of individual policy practices is contextually dependent reflecting design choices and challenges to implementation (Ma et al., 2016). Variable charging systems appear to be more effective than flat charging systems in promoting minimization of waste at the household level, especially for low-income groups as they seek to avoid increased payments, though they can increase risks of illegal dumping (Ma et al., 2016). The most cost-efficient approaches were weight-based pricing, public subsidies and enhanced convenience of collection (e.g., weekly vs bi-weekly) (Ma et al., 2016). Better service delivery and increased perceptions of convenience can potentially increase the effectiveness of economic incentives (Ma et al., 2016).
What we know: Privatisation of municipal solid waste (MSW) services can have mixed effects (Ma et al., 2016). Using public-private partnerships can potentially offer savings for already stretched and limited municipal budgets, but there is no guarantee for improved service provision or reduced costs (Ma et al., 2016). Local government needs to play a significant role in managing this partnership. Recommended actions include ensuring the presence of transparent procedures for awarding contracts, franchises and leases, clear implementation plans, enforcement of regulations for the terms of contracts and established monitoring mechanisms for service provision and quality (Ma et al., 2016).
Examples of implementation: Both the Gent Local Food Policy 'Ghent en Garde' (2016) and Bristol 'Good Food Action Plan' (2015) present activities for incentivising recycling and closed-waste systems. Activities in the Ghent action plan include encouraging on-site household and neighbourhood composting as well developing new business models to close waste cycles such as growing oyster mushrooms from used coffee grounds (Barbour et al., 2022, Supp Material 6). The Bristol plan listed the 'Feed me and Win' campaign, which was an economic incentive programme for residents to participate in food waste recycling. (Barbour et al., 2022, S6).
Examples of implementation: The Toronto (Canada) Long-Term Waste Management Strategy (2016) involves efforts to reduce food waste through decreasing the overall amount of waste food and increasing the amount of food waste captured for diversion. Two related actions proposed were to improve energy recovery from biogas using two anaerobic digesters and to expand and upgrade the capacity of an existing food digester. Through these actions and others within the strategy, Toronto has been able to successfully move toward their goals and have become a leader in organics recycling; in 2016, almost 160,000 tons of source separated organics were collected for anaerobic digestion and/or composting (see Gorrie, 2017, in Barbour et al., 2022).
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