Thesis (MSc.(Med.)(Pharmacy))--University of Limpopo, 2010. / According to the World Health Organisation, there should be an essential medicines
list in every functioning health care system in the world. The Department of Health of
South Africa published its first Essential Drugs List for Primary Health Care in 1996
and for paediatric and hospital use in 1998. The South African Defence Force
published its Military Medicine Code List (MMCL) in 2002. Since the
implementation of the code list in the military service, no research study has been
undertaken to determine adherence to the code list by prescribers or to determine
indicators for possible non-adherence to the MMCL.
The main aim of the study was to evaluate prescribing adherence to the MMCL list by
doctors and nurses in the Primary Health Care military clinics in Gauteng. Further
objectives were to establish indicators for non-adherence and provide suggestions to
improve adherence, to determine to which drugs non-adherence was directed and to
determine the average number of items prescribed per prescription.
A cross-sectional, mainly quantitative, descriptive study was conducted at 14 military
PHC dispensing points in Gauteng. Data were collected retrospectively from 838
prescriptions, of which 348 were written by doctors and 490 by nurses. A
questionnaire was used to collect data prospectively from seven doctors and 34 nurses
on their perceptions of the use of the MMCL.
The prescriptions were analysed for adherence to the stipulations of the MMCL.
Proportions of adherent prescriptions and items were compared between prescriber
type (doctors and nurses), facility type (pharmacies and dispensaries) and facility
location (Northern Region, close to 1 Military Hospital and Southern Region), using
the Chi-square test. Non-adherent items were tabulated and grouped. Data from the
questionnaires were analysed descriptively. Indicators for possible non-adherence and
suggestions for improvement of adherence were listed and grouped.
The average number of items per prescription was 3.4. Overall, 89.9% of
prescriptions (n=838) and 96.4% of items (n=2832) were adherent to the MMCL.
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More prescriptions written by doctors (96,8%) were adherent, compared to nurses
(84,9%; P<0.001). Only a few items were responsible for non-adherence. Nonadherent
items specifically for nurses included corticoid nasal sprays, azithromycin,
meloxicam and ispagula husks. Adherence of prescriptions dispensed in dispensaries
(no pharmacist) (93.0%) was higher compared to pharmacies (87.0%; P<0.004).
Prescriptions from facilities in the South of Gauteng (96.5%) were more adherent than
those near 1 Military Hospital (North) (87.7%; P<0.001). Reasons for non-adherence
included staff shortages, implementation and availability of the MMCL, absence of
standard treatment guidelines (STGs) in the MMCL and delayed referrals to specialist
departments.
Suggestions for improvement of adherence to the MMCL included better
implementation and distribution of the code list, addressing staff shortages, including
Standard Treatment Guidelines (STGs) in the code list and improving the referral
system from clinics to hospitals.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ul/oai:ulspace.ul.ac.za:10386/208 |
| Date | January 2010 |
| Creators | Engelbrecht, Susanna G |
| Publisher | University of Limpopo (Medunsa Campus) |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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