Standardised patient study to assess tuberculosis case detection within the private pharmacy sector in Vietnam

Abstract

BackgroundOf the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB.MethodsA cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs’ referral.ResultsIn total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan.ConclusionsFew SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.

Practices of Community Pharmacists Towards COVID-19 Treatment in Vietnam: A Simulated Client Study

“…The practice of dispensing unlabelled medications at community pharmacies in Vietnam has been reported previously. (13)(14)(15) The preset scenario and data collection form were also piloted with 10 pharmacies which were not included in the study. This helped with validating the scenario as well as assessing the appropriateness and feasibility of both the script and the data collection form.…”

Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study

“…Inappropriate use of quinolones is a major risk factor for producing highly resistant Gram-negative enteric bacteria, resulting in an increased risk of diarrhoeal illness, bacteraemia, and other infections, especially in India [41]. Private pharmacies often dispense antibiotics for clients with chronic cough without referral for TB testing, with the expectation of improving client retention [14,18]. This problem could possibly be addressed by supplying private pharmacies with referral slips, which could allow private pharmacies to dispense a product while maintaining their position relative to client expectations of action [42].…”

“…Given their ubiquity, accessibility and trusted role in local communities [10], private pharmacies are frequently the first point of contact for patients soon after they develop symptoms of TB [11][12][13]. In this context, up to 40% of patients who were ultimately diagnosed with TB visited a private pharmacy prior to medical assessment and TB diagnosis, with 25% of patients continuing to seek advice from private pharmacies even after diagnosis, preferring to avoid doctor consultations [14][15][16].…”

“…While private private pharmacies are positioned to play an important role in case detection and referral, inappropriate management often contributes to delayed diagnosis and TB-specific treatment [14]. Previous studies in India have shown that private pharmacies commonly consortium (https://www.qutubproject.org/), funded by the Bill & Melinda Gates Foundation.…”

Does Physician Over-Service Improve the Quality of Care? A Standardised Patient Audit Study

“…As a result, only 26% of clinical diagnoses and 36% of drug prescriptions were correct (Sylvia et al, 2015). Other developing countries, such as India, Ghana, Kenya, Vietnam and South Africa, face similar problems (Kwan et al, 2019; Zawahir et al, 2021).…”