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Robert Wieder,1,2 Jeffrey L Carson,2,3 Brian L Strom2 1Department of Medicine, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ, USA; 2Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ, USA; 3Department of Medicine, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ, USACorrespondence: Robert WiederRutgers New Jersey Medical School, 205 South Orange Avenue Cancer Center H1296, Newark, NJ 07103, USATel +1 973-972-4871Fax +1 973-972-2668Email wiederro@njms.rutgers.eduBackground: We report faculty affairs lessons from the formation and academic restructuring of Rutgers Biomedical and Health Sciences. Our approach may be a blueprint for development of a new track system that can be adapted by other institutions, after consideration of their own special circumstances.Methods: We created new Appointments and Promotions guidelines consisting of one Tenure Track and four Non-Tenure Tracks, each with different missions. We restructured faculty performance evaluations to include mission-based criteria, an expanded rating scale, and specific expectations. After negotiating these new processes with our faculty union, we enacted central oversight to ensure uniform application of these processes and their associated criteria. We communicated the guidelines and the evaluation system widely. We created programs for universal mentoring, publishing education, diversity, and faculty development.Results: All faculty in our seven schools went through track selection. Anxiety and incomplete understanding improved after implementation. Evaluations with expectations for the following year and an expanded scale for more nuanced assessment served as mentoring tools. Requirements for mentor assignments and diversity education created an atmosphere of nurturing and inclusion. Publications, extramural support, and faculty satisfaction increased after implementation of the guidelines.Conclusion: Lessons included the need to review and learn from guidelines at other institutions, to create tracks that align with different jobs, the necessity for central oversight for uniform application of criteria, the need for extensive and frequent communication with faculty, and that fear of change is only reduced after evidence of success of a new structure. The most important lesson was that faculty rise to expectations when clear, ambitious criteria are delineated and universally applied.Keywords: academic restructuring, faculty tracks, faculty development, faculty mentoring, faculty evaluations, faculty diversity

Background: Croatia has recently introduced reforms to reduce the drug budget deficit without compromising the quality of care. This includes reference pricing for existing drugs in classes where these are seen as essentially similar. This builds on existing reforms, which had already improved prescribing efficiency for both the PPIs and statins. Objectives: Document the influence of recent reforms on the utilisation and expenditure of PPIs and statins. These build on earlier results in recent Pan-EU CNC publications. Methods: Retrospective observational drug utilisation study documenting the influence of recent reforms on utilisation patterns and reimbursed expenditure of PPIs (A02BC) and statins (C10AA) from 2000 to 2010, using 2010 DDDs. Only administrative databases used, and reforms validated with data providers. Previous publications only went up to 2008. Results: Under the new reforms, (a) the reference price for existing drugs (ATC Levels 3 and 4) is based on the lowest price of products with a market share of at least 5% by expenditure during the preceding 12 months, with patients paying the price difference for a more expensive product, (b) there are strict controls for the marketing of drugs including mandatory recording of all promotional expenses and limiting the contact time between pharmaceutical companies and physicians, (c) health insurance expenditure decreased by 13% from 1.7bn Kuna to 1.5bn Kuna ( 0.2bn) first 6 months 2010 vs. similar period in 2009. We fully expect to see similar reductions in expenditure/ DDD for PPIs and statins alongside associated improvements in prescribing efficiency following the recent reforms. This though remains to be substantiated. Conclusions: The recent reforms have reduced drug expenditure in Croatia. We expect there will be similar further improvements in prescribing efficiency for both the PPIs and statins following the recent initiatives. As a result, provide guidance to other countries struggling with resource pressures.

Background: Recent studies have shown considerable variation in generic utilisation depending on initiatives influencing prescribing efficiency. Objectives: Assess the influence of supply and demand side measures on prescribing efficiency. Methods: CN retrospective analysis of reimbursed utilisation (2010 DDDs, DDDs/ TID) and expenditure (and /1000 inhabitants/ year) of PPIs (A02BC) and statins (C10AA) among 19 European countries/ regions principally from 2001 to 2007. Classes chosen as contain originators, generics and patented products with limited differences in effectiveness between them. Years chosen as generics became available in Western EU countries during this time. Supply and demand side reforms validated with countries. No allowance for inflation. Efficiency 3 criteria chosen and validate: No efficiency rate of increase in expenditure exceeds utilisation ; efficient countries - rate of increase in utilisation more than double expenditure ; very efficient countries - reimbursed expenditure typically decreasing despite increasing utilisation. Results: Countries demonstrating considerable efficiency for PPIs through a combination of reforms include Norway, Spain (Catalonia), Sweden and UK. Statins also include Austria and Finland (prescribing restrictions) and Germany (atorvastatin removed from reimbursement list). Countries with more limited/ no efficiency included France, Ireland (GMS population), Portugal and Turkey principally due to limited demand side reforms. This is changing in France through e.g. CAPI. Efficiency considerations hampered in central and eastern European countries as typically only generics reimbursed initially/ over time. Findings reflected in appreciable differences in /1000 inhabitants/ year in 2007, e.g. PPIs: England - 6166 ; France - 15, 194, Portugal - 15, 157 ; Sweden - 5832. Conclusions: Multiple interventions typically needed to change physician prescribing. These coupled with supply side reforms to lower generic prices result in appreciable efficiency differences. Combining CNC DU studies with health policy should become a standard.

Background: Renin-angiotensin (RA) drugs (Angiotensin Converting Enzyme Inhibitors ACEIs and Angiotensin Receptor Blockers ARBs) are accepted treatments for hypertension and Congestive Heart Failure. Coughing can occur with ACEIs leading to development of ARBs. Trials showed though discontinuation due to coughing in a minority of patients on ACEIs (2 3%). ARB prescribing restrictions in Austria as higher costs than ACEIs moderated utilisation. Other demand side measures in Spain (Catalonia) following generic ACEIs also moderated ARB utilisation. Objectives: Document the influence of reforms on ARB utilisation patterns in other European countries (Croatia, Portugal, and Sweden) vs. Austria and Spain (Catalonia) using the 4 Es (education, engineering, economics and enforcement). Methods: Retrospective observational DU study documenting the influence of reforms on utilisation of ACEIs alone/ combination (C09AA01to16, C09BA01 to 15, C09BB02 to 12) and ARBs alone/ combination (C09CA01 to 08, C09DA01 to 07, C09DB01 to 04) from 2001 to 2007 using DDDs. Years chosen to mirror published studies. Only administrative databases used. Utilisation patterns and reforms validated with data providers. Results: (a) RA drug utilisation increased in all countries - 70% to 160%, (b) Prescribing restrictions in Croatia greater influence in moderating ARB utilisation than in Austria enhanced by educational activities (Health Insurance physicians visit primary care physicians where concerns with abuse), (c) Similar moderation of ARBs in Scotland vs. Austria and Croatia helped by intense demand side activities (3 of 4 Es) especially prescribing targets, (d) moderation of ARBs in recent years in Sweden mirroring Spain (Catalonia) with again 3 of 4 Es, (e) growing ARB utilisation in Portugal with limited demand side measures resulted in rising expenditure ( /1000 inhabitants/ year) vs. stabilisation in other EU countries despite increased utilisation. Conclusions: Multiple demand side reforms essential to moderate ARB utilisation. Similar findings in Portugal to PPIs and statins confirms growing utilisation of patented products if only limited demand side initiatives.