Logie Dorothy E, Harding Richard
Cheviot View, Bowden, Melrose, UK.
BMC Public Health. 2005 Aug 10;5:82. doi: 10.1186/1471-2458-5-82.
Despite growing HIV and cancer prevalence in Sub-Saharan Africa, and WHO advocacy for a public health approach to palliative care provision, opioid availability is severely limited. Uganda has achieved a morphine roll-out programme in partnership with the Ministry of Health. This study aimed to evaluate that programme by identifying challenges to implementation that may inform replication.
A multi-methods protocol appraised morphine regulation, storage, prescribing, and consumption in three phases: key informant interviews throughout the opioid supply chain, and direct observation and audit of clinical practice.
Regulation had achieved its goal of preventing misuse and leakage from the supply chain. However, the Government felt that relaxation of regulation was now appropriate. Confusion and complexity in storage and authorization rules led to discontinuation of opioid pain management at the patient level and also wasted service time in trying to obtain supplies to which they were entitled. Continued neglect to prescribe among clinicians and public fear of opioids led to under prescribing, and clinical skills showed some evidence of need for improvement with respect to physical assessment and follow-up.
The Ugandan programme offers a successful model for both advocacy and Governmental support in achieving opioid roll-out across health districts. Despite initial concerns, abuse of opioids has not been evident. Further work is required to ensure that available supplies of opioids are prescribed to those in need, and that clinical standards are met. However, the programme for roll-out has proved a useful model to expand opioid availability as the first step in improving patient care, and may prove a useful template for other Sub-Saharan African countries.
尽管撒哈拉以南非洲地区的艾滋病毒和癌症患病率不断上升，且世界卫生组织倡导采用公共卫生方法提供姑息治疗，但阿片类药物的可及性仍然极为有限。乌干达已与卫生部合作实施了一项吗啡推广计划。本研究旨在通过确定可能为推广提供参考的实施挑战来评估该计划。
采用多方法方案分三个阶段评估吗啡的监管、储存、处方开具和使用情况：对整个阿片类药物供应链中的关键信息提供者进行访谈，并对临床实践进行直接观察和审计。
监管实现了防止滥用和供应链泄漏的目标。然而，政府认为现在放宽监管是合适的。储存和授权规则的混乱与复杂导致患者层面的阿片类药物疼痛管理中断，也浪费了获取其有权获得的供应品所需的服务时间。临床医生持续忽视处方开具以及公众对阿片类药物的恐惧导致处方不足，并且临床技能在身体评估和随访方面显示出一些需要改进的迹象。
乌干达的计划为在各健康区实现阿片类药物推广方面的宣传和政府支持提供了一个成功模式。尽管最初存在担忧，但阿片类药物的滥用并不明显。需要进一步开展工作以确保将现有的阿片类药物供应开给有需要的人，并达到临床标准。然而，推广计划已证明是扩大阿片类药物可及性的有用模式，作为改善患者护理的第一步，并且可能成为其他撒哈拉以南非洲国家的有用模板。
