Contextualising the Perceptions of Pharmacists Practicing Clinical Pharmacy in South Africa—Do We Practice what We Preach?

Abstract

The National Department of Health published their Quality Standards for Healthcare Establishments in South Africa and introduced the National Health Insurance, with the pilot phase that commenced in 2012. The system requires an adequate supply of pharmaceutical personnel and the direct involvement of clinical pharmacists throughout the medication-use process to ensure continuity of care, minimised risk with increasing improvement of patient outcomes. The study aimed to provide insight into the pressing issues of clinical pharmacy practice in South Africa, and sets out to contextualise the current profile of the pharmacist performing clinical functions. The study used a quantitative, explorative, cross-sectional design. The population included pharmacists from private and public tertiary hospitals. A questionnaire was administered, using Typeform™. Ethics approval was obtained from Sefako Makgatho Health Sciences University, National Department of Health and Private Healthcare groups. Categorical data were summarised using frequency counts and percentages; continuous data were summarised by mean values and standard deviations. The sample size included 70 pharmacists practicing clinical pharmacy (private sector n = 59; public sector n = 11). Most participants hold a BPharm degree (busy with MPharm qualification) (64%; n = 70). No statistical significance was found between participants in private and public practice. Most pharmacist agreed (32% (private); n = 59) and strongly agreed (45% (public); n = 11) to have sufficient training to perform pharmaceutical care. The majority respondents felt that interventions made by the pharmacist improved the rational use of medicine (47% (private); 55% (public). Pharmacist interventions influence prescribing patterns (42% (private); 64% (public); and reduce polypharmacy (41% (private); 55% (public). The clinical functions mostly performed were evaluation of prescriptions (private 90%; public 82%), while the top logistical function is daily ordering of medication (40.7%; private), and checking of ward stock (36%; public). Although not all pharmacists appointed in South Africa has completed the MPharm degree in clinical pharmacy, the pharmacists at ward level perform numerous clinical functions, even if only for a small part of their workday. This paper sets the way to standardise practices of clinical pharmacy in South Africa, with a reflection on the differences in practice in different institutions.

Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa

“…South Africa has two sectors for healthcare, the private healthcare sector serving only approximately 15% of the population and the public healthcare sector responsible for the majority [ 20 , 21 ]. Bronkhorst and colleagues (2021) [ 28 ] found that staff-shortages are more pronounced in the public than in private institutional sectors. South Africa’s National Department of Health (NDoH) introduced the National Health Insurance (NHI) and its pilot phase commenced in 2012 [ 29 ].…”

“…In order to bridge the gap, the private sector has created ward-based pharmacist or clinical practice pharmacist posts. Clinical pharmacists across public and private sectors have been reported to perform a variety of functions at ward level [ 28 ]. Among individuals not appointed in dedicated clinical pharmacy positions, higher amotivation (lack or absence of motivation) for delivering clinical pharmacy services were found.…”

“…If allocated more ward-based time, the majority of pharmacists in a study by Bronkhorst et al, felt that they can improve the rational use of medication. They felt that standardised positions with specialist certification, as found in the United States, might enhance practice [ 28 ]. Studies from around the world support this belief [ 30 – 32 ].…”

A VOSviewer-Based Bibliometric Analysis of Prescription Refills

“…However, hospital pharmacy in China and South Africa started in the 1980s and their development was limited by the level of the medical system, leading to the undeveloped prescription refill system. ( 17 , 18 ). In addition, due to the limitations of the included article language, few studies from Japan and other countries were included.…”

“…The United States was the most productive country with 172 publications, followed by the United Kingdom (41 publications), Sweden (20 publications), Canada (18 publications), the Netherlands (16 publications), Australia (14 publications), South Africa (10 publications), China (9 publications), Ireland (6 publications), and Switzerland (6 publications) (Figure 3B). The United States (33), the United Kingdom (18), Sweden (11), and the Netherlands (11) ranked as the top three high H-index countries, while the United States was top 1 (Figure 3A). The top three countries in the total number of citations were the United States (5,191 citations and 5,067 without self-citations), the United Kingdom (923 citations and 882 without self-citations), and Sweden (432 citations and 406 without self-citations), whereas the United States (30.18 citations), the Netherlands (23.81 citations), and the United Kingdom (22.84 citations) were the top three countries in average citations per publication (Figure 3A).…”