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However, a large proportion of medication prescribing and dispensing occurs in primary care settings [ 3].
While we are aware that centralised dispensing occurs in the private sector in other countries, particularly high-income countries, this has not been documented in Africa.
Using the 3-day mean eliminates the possibility that the dispensing occurs before the exposure, whereas when using the 24-hour mean, the dispensing could theoretically occur during the exposure, as the 3-day mean yielded higher OR than the 24-hour mean.
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Thus in the preceding example if the second dispensing occurred on day 35, it would be "banked" and not started until day 40.
Test strips were prorated over a minimum of 30 days if the next dispensing occurred sooner than that, and over a maximum of 60 days if there was no subsequent dispensing during that period.
The 3-day means were calculated for each pollutant and meteorological data based on 24-hour values, giving the running averages of the day when dispensing occurred (index day), one day before and two days before the index day, so the 3-day means included the day of dispensing.
These trend-reversing developments in POA dispensing occurred following – and are likely related to – a variety of recent interventions aiming at improved POA use regulation and control, most prominently including the 'delisting' of Oxycontin® (effective March 2012) from the majority of provincial drug formularies [ 23- 25].
If multiple dispenses occurred at a single dispenser within 4 s of each other, only one dispense event was counted.
The personal identification number allowed checking whether drug dispensing had occurred with seven days intervals, to avoid overlap with control days.
At the same time, we note the observed key changes in POA dispensing levels occurred prior to the launch of a Canadian 'National Prescription Drug Use Strategy' – a package of recommendations and measures aimed at the prevention, surveillance, treatment and enforcement of POA-related problems assembled by various governmental agencies and non-governmental stakeholders – in 2013 [ 55].
The most dispenses (36%) occurred during April to June of each year and there were around five times as many dispenses of ondansetron in 2005 as there were in 2002.
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