Improving access to medicines through centralised dispensing in the public sector: a case study of the Chronic Dispensing Unit in the Western Cape Province, South Africa
Improving access to medicines through centralised dispensing in the public sector: a case study of the Chronic Dispensing Unit in the Western Cape Province, South Africa
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DOI：
10.1186/s12913-015-1164-x
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发表时间：
2015-11-17
影响因子：
2.8
通讯作者：
Ward, Kim
中科院分区：
文献类型：
--
作者：
Magadzire, Bvudzai Priscilla;Marchal, Bruno;Ward, Kim
背景资料：慢性病配药单位是一个外包的公共部门集中配药服务，自2005年以来一直在南非西开普省运作。基民盟为病情稳定的慢性病患者发放药物。其目的是减少药剂师的工作量，减少病人的等待时间和缓解医疗设施的拥挤。我们的目标是描述干预的范围，说明其与卫生系统的接口，并描述其过程和结果。其次，量化的幅度错过了预约登记的患者，并描述其影响，以告知随后的深入实证研究的根本causes.Methods：我们采用了一个案例研究设计，以引出该计划的理论基础的CDU战略。我们咨询了来自省卫生厅的15名高级和中级管理人员，他们与干预措施和承包商密切合作，使用焦点小组讨论和关键线人访谈。此外，相关文献，政策和方案文件进行了审查和analysed.Results：我们发现，CDU的范围显着扩大，在过去的10年中，由于技术进步。因此，在2015年初，基民盟每月生产近30万个包裹。药品供应、患者登记流程、医疗保健专业人员遵守立法和政策、药品分配机制、未领取药品的管理（因患者错过预约而产生）以及所涉行为体的阵列都是基民盟运作的核心。病人错过预约是一个问题，估计每个月有8%-12%的病人受到影响。然而，原因尚未得到彻底调查。错过预约的影响包括成本政府提供的服务由承包商，潜在的损失，由于过期的药品，额外的工作量的承包商和医疗机构的工作人员和潜在的负面治疗结果patient.Conclusions：CDU展示了创新的背景下，压倒性的需求配药慢性疾病的药物。然而，这并不是解决药品获取相关挑战的灵丹妙药。目前正在进行的多层次评估将为如何应对现有挑战提供更多见解。
Background: The Chronic Dispensing Unit (CDU) is an out-sourced, public sector centralised dispensing service that has been operational in the Western Cape Province in South Africa since 2005. The CDU dispenses medicines for stable patients with chronic conditions. The aim is to reduce pharmacists' workload, reduce patient waiting times and decongest healthcare facilities. Our objectives are to describe the intervention's scope, illustrate its interface with the health system and describe its processes and outcomes. Secondly, to quantify the magnitude of missed appointments by enrolled patients and to describe the implications thereof in order to inform a subsequent in-depth empirical study on the underlying causes.Methods: We adopted a case study design in order to elicit the programme theory underlying the CDU strategy. We consulted 15 senior and middle managers from the provincial Department of Health who were working closely with the intervention and the contractor using focus group discussions and key informant interviews. In addition, relevant literature, and policy and programme documents were reviewed and analysed.Results: We found that the CDU scope has significantly expanded over the last 10 years owing to technological advancements. As such, in early 2015, the CDU produced nearly 300,000 parcels monthly. Medicines supply, patient enrollment processes, healthcare professionals' compliance to legislation and policies, mechanisms for medicines distribution, management of non-collected medicines (emanating from patients' missed appointments) and the array of actors involved are all central to the CDU's functioning. Missed appointments by patients are a problem, affecting an estimated 8 %-12 % of patients each month. However, the causes have not been investigated thoroughly. Implications of missed appointments include a cost to government for services rendered by the contractor, potential losses due to expired medicines, additional workload for the contractor and healthcare facility staff and potential negative therapeutic outcomes for patients.Conclusions: The CDU demonstrates innovation in a context of overwhelming demand for dispensing medicines for chronic conditions. However, it is not a panacea to address access-to-medicines related challenges. A multi-level assessment that is currently underway will provide more insights on how existing challenges can be addressed.