Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 4 Articles
Background: Clinical pharmacy service has evolved steadily over the past few decades and is contributing to the\nââ?¬Ë?patient care journeyââ?¬â?¢ at all stages. The service improves safety and effectiveness of medicines, thereby avoiding\nmedication errors. As part of this global shift in pharmacy education and practice, Ethiopian Universities revamped\nthe undergraduate pharmacy curriculum and the first graduates came out in July 2013. These graduates were\nimmediately deployed in public hospital settings, with the ultimate aim of providing clinical pharmacy services. As\nsuch an initiative is new to the Ethiopian pharmacy sector, there is a need to do assessment of the health care\nprovidersââ?¬â?¢ perception and satisfaction towards the service.\nMethods: A cross-sectional survey using self-administered questionnaire was conducted in six regions and one-city\nadministration of the country. Physicians, Health officers and Nurses working along with the new pharmacy\ngraduates formed the study population. A total of 650 healthcare professionals participated in the study. Data were\nentered, cleaned and analyzed using appropriate statistical tools.\nResults: Majority of the health care providers agreed that clinical pharmacy service could have a significant\ncontribution to the patient care. A large proportion of them (70ââ?¬â??90 %) had a positive attitude, although there\nappeared to be some differences across professions. About 50 % of the professionals were of the opinion that\npatient care should be left to the health care providers and pharmacists should concentrate on drug products. In\naddition, the same proportion of respondents said that the setup in their respective hospital was appropriate for\nprovision of clinical pharmacy service. Multivariable analysis indicated that attitude of the health care providers was\nsignificantly associated with year of experience.\nConclusions: A large proportion of the health care providers had positive attitude towards the service, although\nthe extent of the service was below their expectation. Hence, efforts should be in place to organize continuous\nprofessional training for pharmacists and awareness creation forums for other healthcare professionals....
Background: Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring\nmore equitable financing of health care to improve access to health services. This qualitative study examines the\nchallenges and consequences of medicines management policies and practices under the NHIS as perceived by\npublic and private service providers.\nMethods: This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana\nbetween July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of\npublic and private sector providers (government and mission hospitals, private hospitals and private standalone\npharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview\nguides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of\nmedicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and\nalso in response to themes that emerged from the transcripts and notes.\nResults: Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by\nremoving cost barriers for patients; however, some pointed out the increased utilization could also be corollary to\nmoral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low\nreimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs\nreported important differences between private and public sectors including weak separation of prescribing and\ndispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects\nof unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers\n(especially pharmacies and licensed chemical sellers) in the NHIS.\nConclusions: Health providers generally perceive the NHIS to have had a largely positive impact on access to\nmedicines. However, concerns remain about equity in access to medicines and the differences in quality of\npharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the\nimplementation of health insurance schemes is important to identify and address the potential consequences of\nmedicines policies and practices under the scheme....
Background: Cost is a vital component for people with chronic diseases as treatment is expected to be long or\neven lifelong in some diseases. Pharmacist contributions in decreasing the healthcare cost burden of chronic\npatients are not well described due to lack of sufficient evidences worldwide. In developing countries like Nepal,\nthe estimation of direct healthcare cost burden among newly diagnosed diabetics is still a challenge for healthcare\nprofessionals, and pharmacist role in patient care is still theoretical and practically non-existent. This study reports\nthe impact of pharmacist-supervised intervention through pharmaceutical care program on direct healthcare costs\nburden of newly diagnosed diabetics in Nepal through a non-clinical randomised controlled trial approach.\nMethods: An interventional, pre-post non-clinical randomised controlled study was conducted among randomly\ndistributed 162 [control (n = 54), test 1 (n = 54) and test 2 (n = 54) groups] newly diagnosed diabetics by a\nconsecutive sampling method for 18 months. Direct healthcare costs (direct medical and non-medical costs) from\npatients perspective was estimated by ââ?¬Ë?bottom upââ?¬â?¢ approach to identify their out-of-pocket expenses (1USD = NPR\n73.38) before and after intervention at the baseline, 3, 6, 9 and 12 months follow-ups. Test groupsââ?¬â?¢ patients were\nnourished with pharmaceutical care intervention while control group patients only received care from physician/\nnurses. Non-parametric tests i.e. Friedman test, Mannââ?¬â??Whitney U test and Wilcoxon signed rank test were used to\nfind the differences in direct healthcare costs among the groups before and after the intervention (p ââ?°Â¤ 0.05).\nResults: Friedman test identified significant differences in direct healthcare cost of test 1 (p < 0.001) and test 2\n(p < 0.001) groups patients. However, Mannââ?¬â??Whitney U test justified significant differences in direct healthcare cost\nbetween control group and test 1 group, and test 2 group patients at 6-months (p = 0.009, p = 0.010 respectively),\n9-months (p = 0.005, p = 0.001 respectively) and 12-months (p < 0.001, p < 0.001 respectively). Conclusion: Pharmacist supervised intervention through pharmaceutical care program significantly decreased\ndirect healthcare costs of diabetics in test groups compared to control group and hence describes pharmacistââ?¬â?¢s\ncontribution in minimizing direct healthcare cost burden of patients...
Background: The increasing prevalence of chronic diseases puts a high burden on the health care systems of Low\nand Middle Income Countries which are often not adapted to provide the care needed. Peer support programmes\nare promoted to address health system constraints. This case study analyses a peer educator diabetes programme\nin Cambodia, MoPoTsyo, from a health system�s perspective. Which strategies were used and how did these strategies\nchange? How is the programme perceived?\nMethods: Data were collected through semi-structured interviews with patients, MoPoTsyo staff and peer educators,\ncontracted pharmacy staff and health workers, health care workers and non-contracted pharmacists and managers and\npolicy makers at district, provincial and national level. Four areas were purposively selected to do the interviews.\nAn inductive content analysis was done independently by two researchers.\nResults: MoPoTsyo developed into three stages: a focus on diabetes self-management; a widening scope to\nensure affordable medicines and access to other health care services; and aiming for sustainability through more\nintegration with the Cambodian public system and further upscaling. All respondents acknowledged the peer educators�\nrole and competence in patient education, but their ideas about additional tasks and their place in the system differed.\nIndirectly involved stakeholders and district managers emphasized the particular roles and responsibilities of all actors in\nthe system and the particular role of the peer educator in the community. MoPoTsyo�s diagnostics and laboratory services\nwere perceived as useful, especially by patients and project staff. Respondents were positive about the revolving drug\nfund, but expressed concerns about its integration into the government system. The degree of collaboration between\nhealth care staff and peer educators varied.\nConclusion: MoPoTsyo responds to the needs of people with diabetes in Cambodia. Key success factors were: consistent\nfocus on and involvement of the target group, backed up by a strong organisation; simultaneous reduction of other\nbarriers to care; and the ongoing maintenance of relations at all levels within the health system. Despite resistance,\nMoPoTsyo has established a more balanced relationship between patients and health service providers, empowering\npatients to self-manage and access services that meet their needs....
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