Master of Public Health - MPH / This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply. / South Africa

Medication errors are becoming problematic in both hospital and outpatient settings worldwide. Inappropriate use of medication can cause harm to the patient and maintaining high levels of quality patient care is essential to protect all patients. Clinical pharmacy practice contributes to improved patient care by optimising medication therapy; and promoting health, wellness and disease prevention. The involvement of a pharmacist at a ward level has been shown to improve patient care; reduce mortality and morbidity rates; decrease healthcare costs; minimise medication errors; and improve outcomes of drug therapy. However, clinical pharmacy is a fairly new practice in South Africa and there are limited studies available. This study aimed to evaluate the perceived benefits of a ward-based pharmacist on the provision of pharmaceutical care to patients in a hospital setting and to consequently implement a ward-based pharmacy service. The objectives of the study were: (1) to assess, via a questionnaire, the perceptions and attitudes of medical practitioners and nurses to ward-based pharmacy prior to and after implementation of a ward-based pharmacy service, (2) to implement a ward-based pharmacy service in a selected hospital ward; (3) to document and analyse the nature of the work and activities that a ward pharmacist undertakes, and (4) to document and analyse the frequency and nature of ward pharmacist interventions. The study was conducted in a surgical ward of a private hospital in the Eastern Cape. The study design was an intervention study, using a mixed-methods design, with a convergent approach. A convenience sample of 106 patients was obtained over the eight week study period. Participation was voluntary and confidentiality was maintained at all times. Four data collection tools were used during the study and a pilot study was conducted to ensure their validity and reliability. The quantitative data was analysed statistically while the qualitative questions were analysed through coding the various responses. The results of the study showed that medical practitioners and nurses of a surgical ward had a positive attitude towards ward pharmacy both prior to and after the implementation of a ward pharmacy service. There were ward pharmacist interventions made in 50% (n=106) of the patients who participated in the study. A large percentage (57%; 50; n=87) of the ward pharmacist interventions were pharmacist-initiated interventions to optimise patient care while prescribing errors (51%; 19; n=37) were the most commonly occurring medication error. The majority of the medication items involved in the interventions (34%; 34; n=101) were related to the anti-microbial medication class. Overall, there was a 73% (36; n=49) acceptance rate of the ward pharmacist interventions that were made to both the medical practitioners and nurses. There were a number of factors that had a significant relationship with a ward pharmacist intervention being required which included: (1) number of medication items (p=0.001; Chi² test; p<0.0005 Student’s t-test), (2) length of hospital stay (p<0.0005; Chi² test), (3) presence of one or more chronic disease states (p=0.003; Chi² test) and (4) presence of one or more allergies (p=0.028; Chi² test). The ward pharmacist interventions were shown to be of clinical significance and to have a positive impact on the patients concerned. It can be concluded that the ward pharmacy service was beneficial to the patients, medical practitioners and nursing staff.

Thesis (MBA)--Stellenbosch University, 2012. / Sedert die verandering in wetgewing in 2003, bevind die kleinhandel apteeksektor hulself in ‘n baie turbulente omgeweging, omdat die eksterne omgewing dramaties verander het en nuwe kompetisie gedryf deur sakereuse soos Clicks en Dischem hul voortbestaan bedreig. Die instelling van die enkeleindprys (SEP) en verandering in wetgewing oor die eienaarskap van apteke, het die grootste invloed gehad op die kleinhandelapteek sektor. Verder het die aanwysing van voorkeurdiensverskaffers deur mediesefondse die situasie vererger. In Suid-Afrika word die onafhanklike apteek gesien as ‘n voorbeeld van ‘n kleinsakeonderneming en die sleutel suksesfaktore in hierdie besighede kom dan ook sterk ooreen. Hierdie studie, ‘n gevallestudie, fokus dan op die sleutel suksesfaktore en strategiese banaderings wat kleinhandelapteke volg om mededingend te bly in hierdie hoogs kompeterende mark. Die studie is beperk tot die onafhanklike apteek in die Boland-area en inligting was verkry deur middel van ‘n vraelys. Die data is kwantitatief ontleed en verskeie afleidings aangaande die onafhanklike apteeksektor word gemaak. Die resultate toon dat daar geen eenvormige besigheidsmodel tussen die apteke in ons steekproef bestaan nie en dat die onafhanklike apteke in ‘n groot mate nie strategieë en taktiese benaderings het om met korporatiewe mededingers soos Clicks en Dischem te kan meeding nie.

<p>This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply.</p>

The dispensing Medical Practitioner has become topical since 13B4 . Dn this issue, much confusion and ignorance prevails, both amongst members of the medical and allied professions and in the public mind. This study was undertaken to demonstrate some aspects of dispensing of medicines in South Africa and to cansider the implications arising out of the application of legislation governing such dispensing of medicines by family practi tioners. The main objectives of this study were: CaD To identify and ascertain the opinions and policies of all those who are involved and concerned with the dispensing of medicines. Cb) To determine the implications of all the legislation governing the dispensing of medicines on: 1. patient care 2. the dispensing of medicines by doctors Cto their patients}. Information was gathered from a questionnaire sent to service/ consumer groups; from literature review of journals; publications and gazettes; and from legal consultations. The results of the study indicated that: C13 Professional Associations such as, Medical Association of South Africa, the Pharmaceutical Society as well as statutory bodies such as the South African Medical and Dental Council and the Pharmacy Council are concerned with issues such as 'trading in medicine ' and 'profiteering '. Inadequate patient care resulting from the physical, financial and economic hardships suffered by a majority of patients are issues which appear not to have been addressed by these bodies. CE) The fundamental issues of "what is in the best interest of the patient " appears to be ignored in legislation pertaining to dispensing. C33 Dispensing to patients became difficult due to the impractical stringent restrictions imposed by the legislation governing dispensing of medicines. C4D The dispensing of medicines by a doctor is less timB consuming, more convenient and cheaper for the patient as well as for the Sick Benefit Funds. The results were discussed with respect to their theoretical and practical implications and the conclusion reached was that the dispensing legislation presently designed for first world communities, became totally impractical when applied to third world communities, and that most doctors dispense medicines in response to the needs of the individual communities they service. Further research possibilities and recommendations were suggested in order to gain a greater understanding of the dispensing issue, which hopefully will assist to improve the quality of health care and also ensure the best possible advantage for the patient. / Thesis (MMed.)-University of Natal, Durban, 1986.

<p>This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply.</p>

The Council of Australian Therapeutic Advisory Groups (CATAG) (2013) define a Pharmaceutical and Therapeutics Committee (PTC) as a ‘multi-disciplinary team committee with a commitment to the overall governance of the medicines management system in health service organizations to ensure the judicious, appropriate, safe, effective and cost-effective use of medicines’. The multi-disciplinary team includes the health care providers, who are actively participating in the health care systems, such as doctors, pharmacists, nurses, administrators, finance officers, quality improvement managers and other staff members who participate in the medicine use processes according to their knowledge and skills. The major role of this committee is to evaluate and promote rational drug use by health care providers and consumers. In addition, this committee is responsible for developing systems and strategies to prevent adverse medicine reactions and medication errors, enhance rational prescribing and dispensing, provide educational activities and ensure the use of quality and cost-effective medicines. This is a cross-sectional study that was aimed at exploring the structure, activities and functions of public sector institutional Pharmaceutical and Therapeutics Committees (PTC) in the Eastern Cape (EC) Province in South Africa (SA). The primary objectives of the study were to (i) investigate and describe the structure, functions and the activities of the institutional PTCs, and (ii) explore and describe the perception of PTC secretariats on the functionality of the institutional PTCs. A purpose-designed questionnaire including both quantitative and qualitative aspects adapted from other international studies was piloted prior to being used for data collection. The secretariats of the institutional PTCs were requested to complete the questionnaire. Data were analysed using descriptive statistics for the quantitative aspects and thematic analysis for the qualitative component of the questionnaire. Data collection commenced after approval by the relevant ethics committees had been granted. The findings of the study reflected that the majority of the PTCs in the EC province, SA are district/sub-district PTCs which are a cluster of a number of health care institutions in close proximity. The PTC members were appointed by the executive authority as recommended by the literature and other guiding documents. As expected the nurses were dominant as the members of the PTCs in these district/sub-district PTCs. The secretariats were the pharmacists where pharmacists were available and chairperson were doctors. These findings correspond to the recommendations by the National Department of Health PTC policy (2015) and the studies conducted in other countries. A number of PTCs had sub-committees formed e.g. ABC analysis review committee, medicine utilization evaluation (MUE) committee and pharmacovigilance committee to optimise their functionality. Out of 15 PTCs only five PTCs with sub-committees reported functions and interventions, establishment of policies and SOPs. The rest had no outcomes or interventions reported. Poor production of policies and SOPs was observed which differs from other countries’ PTCs. The focus of sub-committees in other countries is the development of formulary and policies related to medicine use. These findings pose a question regarding the functionality and effectiveness of the existing institutional PTCs in the province. In addition, the basic documents that are required to run the PTC were unavailable in a number of PTCs. Barriers to the functionality of PTCs were reported i) Lack of pharmacists and training in PTCs. ii) The rural nature of the EC province and iii) Unavailability of resources including lack of re-imbursement of personal costs. These findings reveal that budget allocation for institutional PTCs is crucial for their functionality. It can be concluded that in the EC province the institutional PTCs which are active and effective are low in number and do not cover all geographical areas. Secondly there is a need for training and educating the PTC members on the role of the PTC members, role of sub-committees, development of policies, SOPs and the basic documents for the functionality of the committee. It is also important that during training the monitoring and evaluation of the effectiveness of the committee is emphasised. Therefore, the choice of the PTC objectives should be measurable as they can assist as indicators of effectiveness. Support by the executive authority has been observed.

Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.

The purpose of this study was to identify and explore factors affecting medicine availability within the district health services. A qualitative descriptive, exploratory and contextual research design was followed. The data collection was conducted through two focus group discussions comprising of pharmaceutical managers and district health services managers respectively. The study found that medicine was not consistently available in the various districts, especially in community health centres and primary health clinics. The factors contributing to the non-availability of medicines include challenges with deliveries from Medical Depots, poor medicine stock management, shortage of pharmacists and pharmacist’s assistants in the facilities, lack of the electronic medicine management systems and the separate existence of Pharmaceutical Services and Medical Depot within the province. The study made recommendations on how to improve medicine availability within the district health services. / Health Studies / M.A. (Health Studies)

The purpose of this study was to identify and explore factors affecting medicine availability within the district health services. A qualitative descriptive, exploratory and contextual research design was followed. The data collection was conducted through two focus group discussions comprising of pharmaceutical managers and district health services managers respectively. The study found that medicine was not consistently available in the various districts, especially in community health centres and primary health clinics. The factors contributing to the non-availability of medicines include challenges with deliveries from Medical Depots, poor medicine stock management, shortage of pharmacists and pharmacist’s assistants in the facilities, lack of the electronic medicine management systems and the separate existence of Pharmaceutical Services and Medical Depot within the province. The study made recommendations on how to improve medicine availability within the district health services. / Health Studies / M.A. (Health Studies)