Shrestha Mina, Moles Rebekah, Ranjit Eurek, Chaar Betty
Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
World Hospital Pharmacy Research Consortium (WHoPReC).
PLoS One. 2018 Feb 5;13(2):e0191778. doi: 10.1371/journal.pone.0191778. eCollection 2018.
Accessibility and affordability of evidence-based medicines are issues of global concern. For low-income countries like Nepal, it is crucial to have easy and reliable access to affordable, good-quality, evidence-based medicines, especially in the aftermath of natural or manmade disasters. Availability of affordable and evidence-based high quality medicines depends on the medicine procurement procedure, which makes it an important aspect of healthcare delivery. In this study, we aimed to investigate medicine procurement practices in hospital pharmacies of Nepal within the framework of International Pharmaceutical Federation [FIP] hospital pharmacy guidelines "the Basel Statements".
We conducted semi-structured interviews with hospital pharmacists or procurement officers in hospital pharmacies of four major regions in Nepal to explore procurement practices. Data were collected until saturation of themes, analysed using the framework approach, and organised around the statements within the procurement theme of the Basel Statements.
Interviews conducted with 53 participants revealed that the procurement guidelines of the Basel Statements were adopted to a certain extent in hospital pharmacies of Nepal. It was found that the majority of hospital pharmacies in Nepal reported using an expensive direct-procurement model for purchasing medicines. Most had no formulary and procured medicines solely based on doctors' prescriptions, which were heavily influenced by pharmaceutical companies' marketing strategies. Whilst most procured only registered medicines, a minority reported purchasing unregistered medicines through unauthorised supply-chains. And although the majority of hospital pharmacies had some contingency plans for managing medicine shortages, a few had none.
Procurement guidelines of the Basel Statements were thus found to be partially adopted; however, there is room for improvement in current procurement practices in hospital pharmacies of Nepal. Adoption and regulation of national and international policies is recommended for enhancing medicine accessibility, as well as improving preparedness for health emergencies during natural disasters and health epidemics.
循证药物的可及性和可负担性是全球关注的问题。对于尼泊尔这样的低收入国家而言，尤其是在自然或人为灾害之后，能够轻松、可靠地获取价格合理、质量优良的循证药物至关重要。价格合理且基于证据的高质量药物的可获得性取决于药品采购程序，这使其成为医疗服务提供的一个重要方面。在本研究中，我们旨在依据国际药学联合会（FIP）医院药房指南“巴塞尔声明”的框架，调查尼泊尔医院药房的药品采购实践。
我们对尼泊尔四个主要地区医院药房的医院药剂师或采购官员进行了半结构化访谈，以探究采购实践。持续收集数据直至主题饱和，采用框架法进行分析，并围绕巴塞尔声明采购主题中的声明进行整理。
与53名参与者进行的访谈显示，尼泊尔医院药房在一定程度上采用了巴塞尔声明的采购指南。研究发现，尼泊尔的大多数医院药房报告称使用昂贵的直接采购模式购买药品。大多数医院没有药品处方集，仅根据医生处方采购药品，而这些处方受制药公司营销策略的严重影响。虽然大多数药房只采购注册药品，但少数药房报告通过未经授权的供应链采购未注册药品。并且，尽管大多数医院药房有一些应对药品短缺的应急计划，但少数药房没有。
因此发现巴塞尔声明的采购指南仅得到部分采用；然而，尼泊尔医院药房目前的采购实践仍有改进空间。建议通过采用和规范国家及国际政策来提高药品可及性，同时提高在自然灾害和健康疫情期间应对突发卫生事件的准备能力。
