Enhancing the role of pharmacists in the cascade of tuberculosis care

Daftary, Amrita; Jha, Nita; Pai, Madhukar

doi:10.1016/j.jegh.2016.05.001

Cited by 18 publications

(21 citation statements)

References 29 publications

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“…The idea of engaging pharmacies in the TB care cascade is not new. They have helped to dispense TB treatment or deliver adherence support 31–33. A few interventions have attempted to improve pharmacy referral of symptomatic patients to the national TB programme or in some cases to private doctors engaged in PPM programmes.…”

Section: Discussionmentioning

confidence: 99%

Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India

et al. 2019

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IntroductionIndia has the world’s highest burden of tuberculosis (TB). Private retail pharmacies are the preferred provider for 40% of patients with TB symptoms and up to 25% of diagnosed patients. Engaging pharmacies in TB screening services could improve case detection.MethodsA novel TB screening and referral intervention was piloted over 18 months, under the pragmatic staggered recruitment of 105 pharmacies in Patna, India. The intervention was integrated into an ongoing public–private mix (PPM) programme, with five added components: pharmacy training in TB screening, referral of patients with TB symptoms for a chest radiograph (CXR) followed by a doctor consultation, incentives for referral completion and TB diagnosis, short message service (SMS) reminders and field support. The intervention was evaluated using mixed methods.Results81% of pharmacies actively participated in the intervention. Over 132.49 pharmacy person-years of observation in the intervention group, 1674 referrals were made and 255 cases of TB were diagnosed. The rate of registration of symptomatic patients was 62 times higher in the intervention group compared with the control group (95% CI: 54 to 72). TB diagnosis was 25 times higher (95% CI: 20 to 32). Microbiological testing and test confirmation were also significantly higher among patients diagnosed in the intervention group (p<0.001). Perceived professional credibility, patient trust, symptom severity and providing access to a free screening test were seen to improve pharmacists’ engagement in the intervention. Workload, patient demand for over-the-counter medicines, doctor consultation fees and programme documentation impeded engagement. An additional 240 cases of TB were attributed to the intervention, and the approximate cost incurred per case detected due to the intervention was US$100.ConclusionsIt is feasible and impactful to engage pharmacies in TB screening and referral activities, especially if working within existing public-private mix (PPM) programmes, appealing to pharmacies’ business mindset and among pharmacies with strong community ties.

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Section: Discussionmentioning

confidence: 99%

Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India

et al. 2019

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“…The intention of this overview was not to conduct an exhaustive, systematic search of the literature; but rather, to identify key themes in the literature and provide a narrative review. Included papers were identified through the reference lists of prior, relevant reviews (including their appendices) [6,[10], [11], [12],[14], [15], [16], [17], [18]]. We included papers concerned with any of the aspects of quality laid out in Table 1, from a quantitative or qualitative perspective.…”

Section: What Quality Of Care Do We Expect From Pharmacies?mentioning

confidence: 99%

Quality of tuberculosis care by pharmacies in low- and middle-income countries: Gaps and opportunities

Miller

Goodman

2020

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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Pharmacies hold great potential to contribute meaningfully to tuberculosis (TB) control efforts, given their accessibility and extensive utilisation by communities in many high burden countries. Despite this promise, the quality of care provided by pharmacies in these settings for a range of conditions has historically been poor. This paper sets out to conceptualise the key issues surrounding quality of TB care in the low- and middle-income country pharmacy setting; examine the empirical evidence on quality of care; and review the interventions employed to improve this. A number of quality challenges are apparent in relation to anti-TB medicine availability, pharmacopeial quality of anti-TB medicines stocked, pharmacy workers’ knowledge, and management of patients both prior to and following diagnosis. Poor management practices include inadequate questioning of symptomatic patients, lack of referral for testing, over-the-counter sale of anti-TB medication as well as unnecessary and harmful medicines (e.g., antibiotics and steroids), and insufficient counselling. Interventions to improve pharmacy practice in relation to TB control have all fallen under the umbrella of public-private mix (PPM) initiatives, whereby pharmacies are engaged into national TB programmes to improve case detection. These interventions all involved training of pharmacists to refer symptomatic patients for testing and have enjoyed reasonable success, although achieving scale remains a challenge. Future interventions would do well to expand their focus beyond case detection to also improve counselling of patients and inappropriate medicine sales. The lack of pharmacy-specific global guidelines and the regulatory environment were identified as key areas for future attention.

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“…In conclusion, we need to think beyond traditional models that expect pharmacists to be able to recognize who may have TB and passively refer TB patients to the public sector [18]. Pharmacists can be engaged for a variety of TB services across the cascade of care, and private pharmacies have been actively engaged in novel PPM models in India that have dramatically increased private sector TB case notifications in the country and improved quality of TB care in the private sector [19].…”

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Quality of tuberculosis care by Indian pharmacies: Mystery clients offer new insights

Miller

Das

Pai

2018

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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For many patients in India, pharmacies are their first point of contact, where most drugs, including antibiotics, can be purchased over-the-counter (OTC). Recent standardised (simulated) patient studies, covering four Indian cities, provide new insights on how Indian pharmacies manage patients with suspected or known tuberculosis. Correct management of the simulated patients ranged from 13% to 62%, increasing with the certainty of the TB diagnosis. Antibiotics were frequently dispensed OTC to patients, with 16% to 37% receiving such drugs across the cases. On a positive note, these studies showed that no pharmacy dispensed first-line anti-TB drugs. Engagement of pharmacies is important to not only improve TB detection and care, but also limit the abuse of antibiotics.

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Enhancing the role of pharmacists in the cascade of tuberculosis care

Cited by 18 publications

References 29 publications

Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India

Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India

Quality of tuberculosis care by pharmacies in low- and middle-income countries: Gaps and opportunities

Quality of tuberculosis care by Indian pharmacies: Mystery clients offer new insights

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