乌干达私营药店遵守管制处方药法规的情况：一项混合方法研究。
Compliance of private pharmacies in Uganda with controlled prescription drugs regulations: a mixed-methods study.
机构信息
Department of Pharmacy, College of Heath Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda.
Department of Internal Medicine, College of Heath Sciences, Makerere University, P. O Box, 7072, Kampala, Uganda.
出版信息
Subst Abuse Treat Prev Policy. 2020 Feb 18;15(1):16. doi: 10.1186/s13011-020-00261-x.
BACKGROUND
Controlled prescription drug use disorders are a growing global health challenge in Sub-Saharan Africa. Effective supply chain regulations on dispensing and stock control are important for controlling this epidemic. Since compliance with these regulations in resource-limited countries is poor, there is need to understand its predictors in order to reduce the risk of prescription drug use disorders.
METHODS
A mixed-methods study utilizing a structured questionnaire and a simulated client guide was undertaken in Kampala and Mbale towns in Uganda. The questionnaire recorded self-reported dispensing and verified stock control practices and their covariates from 101 private pharmacies. The guide recorded actual dispensing practices from 27 pharmacies. Snowball sampling was done to enrich the sample with pharmacies that stock opioids. The mean compliance with good dispensing and stock control practices was calculated. Multivariate logistic regression analyses were applied to identify predictors of compliance.
RESULTS
The mean compliance with dispensing and stock control requirements was 82.9% and 23%, respectively. Twenty percent and 40% of the pharmacies dispensed pethidine without a prescription and with invalid prescriptions, respectively. Having a pharmacist on duty (OR = 5.17; p = 0.02), prior in-service training on narcotics regulations (OR = 3.51; p = 0.04), and previous narcotics audits by the regulator (OR = 5.11; p = 0.01) were independent predictors of compliance with stock control requirements. Pharmacies with a previous history of poor compliance with dispensing requirements were less likely to demonstrate good compliance (OR = 0.21; p = 0.01).
CONCLUSIONS
There is suboptimal compliance to controlled prescription drug regulations among Uganda's pharmacies. A previous history of poor compliance to dispensing requirements predicted low compliance in subsequent assessments. Training and regulatory audits increased compliance in stock control but not dispensing. Expansion of training and audits to more pharmacies and/or incentives for compliance are necessary.
背景
在撒哈拉以南非洲地区，受管制的处方药物使用障碍是一个日益严重的全球健康挑战。有效的供应链监管对于控制这一流行疾病至关重要。由于资源有限的国家对这些法规的遵守情况不佳，因此需要了解其预测因素，以降低处方药物使用障碍的风险。
方法
在乌干达的坎帕拉和姆巴莱镇进行了一项混合方法研究，使用了结构化问卷和模拟客户指南。该问卷记录了 101 家私人药店的自我报告配药和经核实的库存控制实践及其协变量。该指南记录了 27 家药店的实际配药实践。采用雪球抽样法，用储存阿片类药物的药店丰富样本。计算了良好配药和库存控制实践的平均合规率。应用多变量逻辑回归分析来确定合规性的预测因素。
结果
配药和库存控制要求的平均合规率分别为 82.9%和 23%。20%和 40%的药店分别在没有处方和使用无效处方的情况下分发了哌替啶。有值班药剂师（OR=5.17；p=0.02）、先前接受过麻醉品法规在职培训（OR=3.51；p=0.04）和监管机构以前对麻醉品进行的审计（OR=5.11；p=0.01）是遵守库存控制要求的独立预测因素。以前在配药要求方面合规性差的药店不太可能表现出良好的合规性（OR=0.21；p=0.01）。
结论
乌干达的药店对管制处方药物法规的遵守情况不佳。以前在配药要求方面的合规性不佳预测了随后评估中的低合规性。培训和监管审计增加了对库存控制的合规性，但对配药没有影响。需要向更多的药店扩大培训和审计范围，或采取激励措施以提高合规性。
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