Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
S Afr Fam Pract (2004). 2021 Aug 24;63(1):e1-e8. doi: 10.4102/safp.v63i1.5274.
The number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa.
Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively.
A total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication.
A mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.
南非慢性病患者人数众多，这对医疗体系构成了挑战。为应对新冠疫情，开普敦的卫生服务部门开始由社区卫生工作者为患者提供送药上门服务。在为未来规划时，他们要求对南非初级卫生保健中为患者送药的替代机制进行范围界定审查。
采用全面的检索策略，系统地在数据库中进行检索，以确定过去 10 年的研究。遵循范围界定审查的方法学指南。使用标准模板提取数据并比较研究特征和结果。对数据进行定量和定性分析。
共确定了 4253 篇文献，其中纳入了 26 篇。大多数文献发表于过去 5 年（n = 21），为研究报告（n = 24），来自西开普省（n = 15），主要聚焦于依从俱乐部（n = 17）、替代取药点（n = 14）、送药上门（n = 5）和艾滋病（n = 17）。大多数替代机制都得到了集中配药和包装系统的支持。新型技术，如智能储物柜和自动化药房配药机，已进行试点。患者从这些替代方案中受益，依从性得到提高。现有证据表明，替代机制比患者去医疗机构取药更便宜、更有益。
理想情况下，应根据当地情况和患者选择，提供各种量身定制的方案，这些方案应能得到系统的有效管理。需要对替代方案进行更多的经济评估，特别是在扩大规模和应用新技术之前。
