Oqua Dorothy, Agu Kenneth Anene, Isah Mohammed Alfa, Onoh Obialunamma U, Iyaji Paul G, Wutoh Anthony K, King Rosalyn C
Howard University Pharmacists And Continuing Education (PACE) Center, Plot 1073 J. S. Tarka Street, Area 3, Garki PO BOX 10435, Abuja, Nigeria.
Springerplus. 2013 Oct 17;2:525. doi: 10.1186/2193-1801-2-525. eCollection 2013.
The use of medicines is an essential component of many public health programs (PHPs). Medicines are important not only for their capacity to treat and prevent diseases. The public confidence in healthcare system is inevitably linked to their confidence in the availability of safe and effective medicines and the measures for ensuring their rational use. However, pharmacy services component receives little or no attention in most public health programs in developing countries. This article describes the strategies, lessons learnt, and some accomplishments of Howard University Pharmacists and Continuing Education (HU-PACE) Centre towards improving hospital pharmacy practice through PHP in Nigeria.
In a cross-sectional survey, 60 hospital pharmacies were randomly selected from 184 GHAIN-supported health facilities. The assessment was conducted at baseline and repeated after at least 12 months post-intervention using a study-specific instrument. Interventions included engagement of stakeholders; provision of standards for infrastructural upgrade; development of curricula and modules for training of pharmacy personnel; provision of job aids and tools amongst others. A follow-up hands-on skill enhancement based on identified gaps was conducted. Chi-square was used for inferential statistics. All reported p-values were 2-tailed at 95% confidence interval.
The mean duration of service provision at post-intervention assessment was 24.39 (95% CI, 21.70-27.08) months. About 16.7% of pharmacies reported been trained in HIV care at pre-intervention compared to 83.3% at post-intervention. The proportion of pharmacies with audio-visual privacy for patient counseling increased significantly from 30.9% at pre-intervention to 81.4% at post-intervention. Filled prescriptions were cross-checked by pharmacist (61.9%) and pharmacy technician (23.8%) before dispensing at pre-intervention compared to pharmacist (93.1%) and pharmacy technician (6.9%) at post intervention. 40.0% of pharmacies reported tracking consumption of drugs at pre-intervention compared to 98.3% at post-intervention; while 81.7% of pharmacies reported performing periodic stock reconciliation at pre-intervention compared to 100.0% at post-intervention. 36.5% of pharmacies were observed providing individual counseling on medication use to patients at pre-intervention compared to 73.2% at post-intervention; and 11.7% of pharmacies had evidence of monitoring and reporting of suspected adverse drug reaction at pre-intervention compared to 73.3% at post-intervention. The institution of access to patients' clinical information by pharmacists in all pharmacies at post-intervention was a paradigm shift.
Through public health program, HU-PACE created an enabling environment and improved capacity of pharmacy personnel for quality HIV/AIDS and TB services. This has contributed in diverse ways to better monitoring of patients on pharmacotherapy by pharmacists through access of pharmacists to patients' clinical information.
药品的使用是许多公共卫生项目（PHPs）的重要组成部分。药品不仅因其治疗和预防疾病的能力而重要。公众对医疗保健系统的信心不可避免地与他们对安全有效药品的可及性以及确保其合理使用的措施的信心相关联。然而，在发展中国家的大多数公共卫生项目中，药房服务部分很少或根本没有受到关注。本文描述了霍华德大学药剂师与继续教育（HU-PACE）中心在尼日利亚通过公共卫生项目改善医院药房实践的策略、经验教训和一些成果。
在一项横断面调查中，从184个由全球抗击艾滋病营养与人口健康项目（GHAIN）支持的卫生设施中随机选择了60家医院药房。使用特定研究工具在基线时进行评估，并在干预后至少12个月重复评估。干预措施包括让利益相关者参与；提供基础设施升级标准；开发培训药房人员的课程和模块；提供工作辅助工具等。根据识别出的差距进行了后续的实践技能提升。使用卡方检验进行推断统计。所有报告的p值在95%置信区间为双侧。
干预后评估时的平均服务提供时长为24.39（95%置信区间，21.70 - 27.08）个月。干预前约有%的药房报告接受过艾滋病护理培训，干预后这一比例为83.3%。有视听隐私用于患者咨询的药房比例从干预前的30.9%显著增加到干预后的81.4%。干预前，调配前由药剂师（61.9%）和药房技术员（23.8%）对已配处方进行核对，干预后则是药剂师（93.1%）和药房技术员（6.9%）。干预前40.0%的药房报告跟踪药品消耗情况，干预后这一比例为98.3%；干预前81.7%的药房报告进行定期库存核对，干预后为100.0%。干预前观察到36.5%的药房为患者提供用药个体化咨询服务干预后为73.2%；干预前11.7%的药房有监测和报告疑似药物不良反应的证据，干预后为73.3%。干预后所有药房的药剂师都能获取患者临床信息，这是一个范式转变。
通过公共卫生项目，HU-PACE创造了有利环境，提高了药房人员提供优质艾滋病/艾滋病和结核病服务的能力。这通过多种方式有助于药剂师通过获取患者临床信息更好地监测接受药物治疗的患者。
