Adherence to treatment guidelines in primary health care facilities in Botswana

Boonstra, Eelco; Lindbæk, Morten; Khulumani, P; Ngome, Enock; Fugelli, P

doi:10.1046/j.1365-3156.2002.00842.x

Cited by 33 publications

(38 citation statements)

References 7 publications

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“…The proposed optimal range for an injection prescribed is 13.4–24.1% (Table 1). In contrast to our findings, the percentage of encounters with an injection prescribed was 17% in Afghanistan [25], 18% in Lao People’s [44], 9% in Botswana [20], 10% in Burundi [40] and 9.1% in Kuwait [45]. However, in some countries, the percentage of encounters with an injection prescribed was even higher than our findings for example, 45.8% in India [35], 57.6% in Cambodia [40], 41.8% in Cameroon [46] and 80% in Ghana [27].…”

Section: Discussioncontrasting

confidence: 99%

“…In contrast to our findings, the average number of drugs per encounter was lower in a majority of developing countries (range = 1.3–3.0). For example, this value was 3.0 in Sri Lanka [17], 2.1 in Nepal [18], 2.2 in Vietnam [19], 2.3 in Botswana [20], 2.3 in Burkina Faso [21], 1.8 in Malawi [22], 1.4 in Sudan [23] and 1.3 in Zimbabwe [24]. However, the average number of drugs per encounter was higher in Afghanistan (3.9) [25], India (5.6) [26], Ghana (4.8) [27] and Nigeria (5.2) [28].…”

Section: Discussionmentioning

confidence: 99%

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Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan

Atif

Sarwar

Azeem

et al. 2016

BMC Health Serv Res

106

185

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BackgroundProper utilization of medicines is a critical component of pharmaceutical care plan. The aim of this study was to assess drug use pattern at ten primary healthcare centers (PHCCs) of the Bahawalpur district of the Punjab province of Pakistan by employing the WHO/INRUD core drug use indicators.MethodsThis was a descriptive, non-experimental and cross-sectional study. For the prescribing indicators, 1000 prescriptions (100 prescriptions per PHCC) were systematically sampled out of the total 290,000 prescriptions written during January to December 2014. A total of 300 randomly selected patients (30 per PHCC) and 10 pharmacy personnel (one per PHCC) were observed and interviewed to investigate the patient-care and facility-specific indicators, respectively. We used published ideal standards for each of the WHO/INRUD indicators.ResultsAmong the prescribing indicators, the average number of drugs per encounter was 3.4 (SD = 0.8) (optimal range = 1.6–1.8), the drugs prescribed by the generic name were 71.6% (optimal value = 100%), the encounters with an antibiotic prescribed were 48.9% (optimal range = 20.0–26.8%), the encounters with an injection prescribed were 27.1% (optimal range = 13.4–24.1%) and the drugs prescribed from the Essential Drugs List (EDL) were 93.4% (optimal value = 100%). Among the patient-care indicators, the average consultation time was 2.2 min (SD = 0.8) (optimal value ≥10 min), the average dispensing time was 38 s (SD = 12.1) (optimal value ≥90 s), the percentage of drugs actually dispensed was 90.9% (optimal value = 100%), the percentage of drugs adequately labeled was 100% (optimal value = 100%) and the patients’ knowledge of correct dosage was 62.1% (optimal value = 100%). Among the facility-specific indicators, all PHCCs had a copy of the EDL and the key drugs available in the stock were 82% (optimal value = 100%).ConclusionsIrrational use of drugs was observed in all healthcare facilities. This study necessitates the need to implement the WHO/INRUD recommended 12 core interventions to promote rational use of medicines.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan

Atif

Sarwar

Azeem

et al. 2016

BMC Health Serv Res

106

185

View full text Add to dashboard Cite

show abstract

“…The proposed optimal range for an injection prescribed is 13.4-24.1% (Table 1). In contrast to our findings, the percentage of encounters with an injection prescribed was 17% in Afghanistan [25], 18% in Lao People's [44], 9% in Botswana [20], 10% in Burundi [40] and 9.1% in Kuwait [45]. However, in some countries, the percentage of encounters with an injection prescribed was even higher than our findings for example, 45.8% in India [35], 57.6% in Cambodia [40], 41.8% in Cameroon [46] and 80% in Ghana [27].…”

Section: Prescribing Indicatorscontrasting

confidence: 99%

Assessment Of Core Drug Use Indicators Using Who/Inrud Methodology At Primary Health Care Centers In Bahawalpur, Pakistan

et al. 2016

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Background: Proper utilization of medicines is a critical component of pharmaceutical care plan. The aim of this study was to assess drug use pattern at ten primary healthcare centers (PHCCs) of the Bahawalpur district of the Punjab province of Pakistan by employing the WHO/INRUD core drug use indicators. Methods: This was a descriptive, non-experimental and cross-sectional study. For the prescribing indicators, 1000 prescriptions (100 prescriptions per PHCC) were systematically sampled out of the total 290,000 prescriptions written during January to December 2014. A total of 300 randomly selected patients (30 per PHCC) and 10 pharmacy personnel (one per PHCC) were observed and interviewed to investigate the patient-care and facility-specific indicators, respectively. We used published ideal standards for each of the WHO/INRUD indicators. Results: Among the prescribing indicators, the average number of drugs per encounter was 3.4 (SD = 0.8) (optimal range = 1.6-1.8), the drugs prescribed by the generic name were 71.6% (optimal value = 100%), the encounters with an antibiotic prescribed were 48.9% (optimal range = 20.0-26.8%), the encounters with an injection prescribed were 27.1% (optimal range = 13.4-24.1%) and the drugs prescribed from the Essential Drugs List (EDL) were 93.4% (optimal value = 100%). Among the patient-care indicators, the average consultation time was 2.2 min (SD = 0.8) (optimal value ≥10 min), the average dispensing time was 38 s (SD = 12.1) (optimal value ≥90 s), the percentage of drugs actually dispensed was 90.9% (optimal value = 100%), the percentage of drugs adequately labeled was 100% (optimal value = 100%) and the patients' knowledge of correct dosage was 62.1% (optimal value = 100%). Among the facility-specific indicators, all PHCCs had a copy of the EDL and the key drugs available in the stock were 82% (optimal value = 100%). Conclusions: Irrational use of drugs was observed in all healthcare facilities. This study necessitates the need to implement the WHO/INRUD recommended 12 core interventions to promote rational use of medicines.

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“…36 During undergraduate training in nursing they learn consultation skills, including how to assess patients, make a diagnosis and prescribe medication. In addition to general nursing training, Botswana has established postgraduate education centres to develop family nurse practitioners.…”

Section: Botswana's Art Programmementioning

confidence: 99%

Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana

Miles

Clutterbuck

Seitio³

et al. 2007

Bull World Health Organ

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Problem As programmes to deliver antiretroviral therapy (ART) are implemented in resource-constrained settings, the problem becomes not how these programmes are going to be financed but who will be responsible for delivering and sustaining them. Approach Physician-led models of HIV treatment and care that have evolved in industrialized countries are not replicable in settings with a high prevalence of HIV infection and limited access to medical staff. Therefore, models of care need to make better use of available human resources. Local setting Using Botswana as an example, we discuss how nurses are underutilized in long-term clinical management of patients requiring ART. Relevant changes We argue that for ART-delivery programmes to be sustainable, nurses will need to provide a level of clinical care for patients receiving this therapy, including prescribing ART and managing common adverse effects. Lessons learned Practicalities involved in scaling up nurse-led models of ART delivery include overcoming political and professional barriers, identifying educational requirements, agreeing on the limitations of nursing practice, developing clear referral pathways between medical and nursing personnel, and developing mechanisms to monitor and supervise practice. Operational research is required to demonstrate that such models are safe, effective and sustainable.

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Adherence to treatment guidelines in primary health care facilities in Botswana

Cited by 33 publications

References 7 publications

Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan

Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan

Assessment Of Core Drug Use Indicators Using Who/Inrud Methodology At Primary Health Care Centers In Bahawalpur, Pakistan

Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana

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