Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
Br J Clin Pharmacol. 2023 Jan;89(1):20-33. doi: 10.1111/bcp.14716. Epub 2021 Feb 10.
Irrational medicine use is a global crisis, but incidences are proportionately higher in low- and middle-income countries such as Sierra Leone. This study explores the structure, functions and challenges of drug and therapeutics committees (DTCs), an intervention towards irrational medicine use recently piloted in Sierra Leone.
A 2-phase mixed-method study design was used in this study. Firstly, a cross-sectional survey was conducted on all pharmacists who have worked for at least 1 year in DTC-piloted hospitals, using an online questionnaire to assess DTCs' structure, indicators and challenges. In phase 2, all eligible pharmacists were invited for a semistructured online interview using the WhatsApp messaging application to get deeper insights into the key issues that emerged from the survey; however, only 5 of the 7 consented to participate. MS Excel 2019 and NVivo version 12 were respectively used for data management and analysis.
A total of 6 survey responses and 5 interviews were included in the analysis. Participants are pharmacists from the 7 hospitals in Sierra Leone where DTC was piloted. Most DTCs are comprised of a minimum of 10 members consisting of both medical and hospital administrative staff. The main functions of DTCs are ensuring rational medicines use, monitoring and reporting adverse drug reactions. All 7 hospitals with established pilot DTCs have different subcommittees operating at varying functionality levels, ranging from effective to nonfunctional. The main challenges in DTC functions and maintenance are funding (n = 6), DTC decision implementation (n = 4), and unmotivated members (n = 4). Strategies suggested to improve DTCs at public hospitals and nationwide include resource allocation, monitoring and evaluating DTC functions and its members' capacity building.
DTCs present a compelling opportunity towards achieving rational medicines use at the hospital level in Sierra Leone. Nonetheless, the lack of funding and operational resources are significant limitations that must be noted by policymakers before expanding DTC programmes to other hospitals in Sierra Leone.
不合理用药是一个全球性危机，但在塞拉利昂等中低收入国家，这种情况的比例更高。本研究探讨了药物治疗委员会（DTC）的结构、功能和挑战，这是最近在塞拉利昂试点的一项针对不合理用药的干预措施。
本研究采用了两阶段混合方法设计。首先，对所有在试点 DTC 医院工作至少 1 年的药剂师进行了横断面调查，使用在线问卷评估 DTC 的结构、指标和挑战。在第 2 阶段，邀请所有符合条件的药剂师使用 WhatsApp 消息应用程序进行半结构化在线访谈，以更深入地了解调查中出现的关键问题；然而，只有 7 名参与者中的 5 名同意参加。分别使用 Microsoft Excel 2019 和 NVivo 版本 12 进行数据管理和分析。
共纳入 6 份调查回复和 5 份访谈进行分析。参与者是塞拉利昂 7 家试点 DTC 医院的药剂师。大多数 DTC 由至少 10 名成员组成，成员包括医疗和医院行政人员。DTC 的主要功能是确保合理用药、监测和报告药物不良反应。所有 7 家已建立试点 DTC 的医院都有不同功能水平运作的小组委员会，从有效到非功能。DTC 功能和维护方面的主要挑战包括资金（n=6）、DTC 决策执行（n=4）和成员缺乏积极性（n=4）。建议采取的改善公立医院和全国 DTC 的策略包括资源分配、监测和评估 DTC 功能及其成员的能力建设。
DTC 为在塞拉利昂实现医院层面的合理用药提供了一个引人注目的机会。然而，缺乏资金和运营资源是决策者在将 DTC 计划扩大到塞拉利昂其他医院之前必须注意的重大限制。
