1
|
Bello K, De Lepeleire J, Kabinda M. J, Bosongo S, Dossou JP, Waweru E, Apers L, Zannou M, Criel B. The expanding movement of primary care physicians operating at the first line of healthcare delivery systems in sub-Saharan Africa: A scoping review. PLoS One 2021; 16:e0258955. [PMID: 34679111 PMCID: PMC8535187 DOI: 10.1371/journal.pone.0258955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In sub-Saharan Africa (SSA), the physicians' ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs' practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare. METHODS We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders. FINDINGS We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, "médecins généralistes communautaires", and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs' governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs' activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa. CONCLUSIONS This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs.
Collapse
Affiliation(s)
- Kéfilath Bello
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, General Practice, KU Leuven—University of Leuven, Leuven, Belgium
| | - Jeff Kabinda M.
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Democratic Republic of Congo
| | - Samuel Bosongo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Democratic Republic of Congo
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Evelyn Waweru
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ludwig Apers
- Department Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marcel Zannou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
- Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
2
|
Sake FTN, Wong K, Bartlett DJ, Saini B. Benzodiazepine use risk: Understanding patient specific risk perceptions and medication beliefs. Res Social Adm Pharm 2018; 15:1317-1325. [PMID: 30639048 DOI: 10.1016/j.sapharm.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Benzodiazepines are widely prescribed psychotropic medications. These medications have the potential to cause alertness impairing effects and their prolonged use is associated with serious adverse effects. Despite the listed adverse health outcomes and provision of warnings, many benzodiazepine users tend to ignore the safety information and use them inappropriately. OBJECTIVE To elicit the risk perceptions of benzodiazepine users and explore the association of risk perceptions with their socio-demographic factors or medication use profiles (e.g. past withdrawal attempt, length of use and future willingness to try behavioural alternatives). METHODS Point of purchase surveys were conducted with patients who were supplied benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included questions about patient's demographic characteristics, their past attempt for withdrawing benzodiazepines and their future intention to consider alternative behavioural therapies. The validated Beliefs about Medications Questionnaire (BMQ-specific) and a customised scale assessing risk perception were included in the survey. Data obtained from the surveys were entered into the IBM SPSS package (Version 22.0) and subjected to descriptive, correlational and regression analyses. RESULTS Seventy-five patients (67% female, a mean age of 54.3) obtaining benzodiazepines from 12 pharmacies were recruited for the survey. Participant's beliefs regarding potential side effects of benzodiazepines and their level of education were significantly associated with their risk perception scores. While the overall risk perception scores did not influence patient's previous attempts to withdraw benzodiazepines, the risk perception score about immediate effects of benzodiazepines (within 3-4 h of consumption) was a predictor of preference for behavioural therapies. Eighty-three percent (n = 62) of the participants believed that pharmacists can play a key role in improving risk perceptions of consumers around benzodiazepine use. CONCLUSIONS Individual patient characteristics and their beliefs about medications significantly influence their perception of risk about benzodiazepine use. The findings of this study suggest that pharmacist support can be utilized in effective risk communication, promoting the safe use of benzodiazepines and in facilitating the uptake of relevant behavioural interventions as alternatives to benzodiazepines.
Collapse
Affiliation(s)
| | - Keith Wong
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, NSW, Australia
| | - Delwyn J Bartlett
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| | - Bandana Saini
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia
| |
Collapse
|
3
|
Herrera-Gómez F, Gutierrez-Abejón E, Criado-Espegel P, Álvarez FJ. The Problem of Benzodiazepine Use and Its Extent in the Driver Population: A Population-Based Registry Study. Front Pharmacol 2018; 9:408. [PMID: 29755352 PMCID: PMC5933078 DOI: 10.3389/fphar.2018.00408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/09/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Benzodiazepines are driving-impairing medicines (DIM). This study presents current consumption of dispensed benzodiazepines in the Spanish general population, with a focus in pattern of use and concomitant medicines consumed with. Methods: A population-based registry study was carried out to assess the year-2016 granted benzodiazepines dispensation in Castile and León. Weighting was performed to obtain the adjusted benzodiazepine consumption for licensed drivers according to age and gender using our national drivers' license census data. Results: Benzodiazepines were used by 15.38% of the general population and 10.97% of drivers. Nearly 2% of the population and more than 1% of drivers took these medicines every day. The amount consumed (until 3 or more benzodiazepines per day) and concomitant use of other DIM were also higher. Women were the most frequent consumers, and anxiolytic use was usual. Consumption increases with age, but there were differences between men and women drivers from 60 years old. Conclusions: The current use of benzodiazepines must serve to awareness of the healthcare personnel, patients, and authorities on their risks, above all on the road safety.
Collapse
Affiliation(s)
- Francisco Herrera-Gómez
- Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain.,Nephrology, Hospital Virgen de la Concha - Sanidad de Castilla y León, Zamora, Spain
| | - Eduardo Gutierrez-Abejón
- Technical Direction of Pharmaceutical Assistance, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - Paloma Criado-Espegel
- Technical Direction of Pharmaceutical Assistance, Gerencia Regional de Salud de Castilla y León, Valladolid, Spain
| | - F Javier Álvarez
- Pharmacology and Therapeutics, Faculty of Medicine, University of Valladolid, Valladolid, Spain.,CEIm Área de Salud Valladolid Este, Hospital Clínico Universitario de Valladolid - Sanidad de Castilla y León, Valladolid, Spain
| |
Collapse
|
4
|
Khanra S. Benzodiazepine misuse: When shall we wake up? Asian J Psychiatr 2017; 29:134-135. [PMID: 29061411 DOI: 10.1016/j.ajp.2017.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, ICARE Institute of Medical Sciences & Research, Haldia 721645, India.
| |
Collapse
|
5
|
When you can't have the cake and eat it too: a study of medical doctors' priorities in complex choice situations. Soc Sci Med 2012; 75:1964-73. [PMID: 22951011 DOI: 10.1016/j.socscimed.2012.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 08/05/2012] [Accepted: 08/07/2012] [Indexed: 11/21/2022]
Abstract
Available literature provides little insight into medical doctors' prescription choices when they are required to make complex trade-offs between different concerns such as treatment effect, costs, and patient preferences simultaneously. This study investigates this issue. It is based on a Discrete Choice Experiment (DCE) conducted with 571 Norwegian doctors, where the DCE captures preferences for medications described along five dimensions important for both clinical decision-making and prioritisation in the health sector. Although effectiveness is the most important determinant of choice in our study, doctors also put considerable weight on patients' preferences and on avoiding high total costs. The probability of choosing a particular medication increases when doctors have a positive experience with the medication. GPs value high clinical effectiveness less than hospital consultants do. They are also less concerned with patient preferences. For both groups of doctors it turns out that they are willing to make difficult trade-offs between attributes they are often assumed not to be willing to compromise on, like effectiveness or patient preferences, and cost measures - given that they have proper information about these attributes.
Collapse
|
6
|
McBain R, Norton DJ, Morris J, Yasamy MT, Betancourt TS. The role of health systems factors in facilitating access to psychotropic medicines: a cross-sectional analysis of the WHO-AIMS in 63 low- and middle-income countries. PLoS Med 2012; 9:e1001166. [PMID: 22303288 PMCID: PMC3269418 DOI: 10.1371/journal.pmed.1001166] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 12/14/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. METHODS AND FINDINGS This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. CONCLUSIONS Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability.
Collapse
Affiliation(s)
- Ryan McBain
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
| | | | | | | | | |
Collapse
|
7
|
Firmino KF, Abreu MHNGD, Perini É, Magalhães SMSD. Utilização de benzodiazepínicos no Serviço Municipal de Saúde de Coronel Fabriciano, Minas Gerais. CIENCIA & SAUDE COLETIVA 2012; 17:157-66. [DOI: 10.1590/s1413-81232012000100018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 02/26/2010] [Indexed: 11/21/2022] Open
Abstract
Neste estudo foram avaliadas as indicações de benzodiazepínicos no Serviço Municipal de Saúde de Coronel FabricianoMG, verificando sua conformidade com o preconizado pela literatura. O estudo avaliou todas as receitas desses medicamentos provenientes das Unidades Municipais de Saúde no período de Setembro a Outubro de 2006, os formulários de indicação clínica preenchidos pelo prescritor e cadastros informatizados do serviço. Analisaram-se 1.866 receitas, sendo 59,7% do Diazepam e o restante do Clonazepam. A Dose Diária Definida por mil habitantes por dia foi de 24,69 para o Diazepam e de 3,58 para o Clonazepam. Cerca de 50% das indicações relatadas pelos médicos foram como hipnótico ou ansiolítico, 21,9% para "uso crônico/dependência" e o restante para outras indicações. Das receitas que atenderam aos critérios de inclusão para análise da adequação da indicação (1618), cerca de 70% foram consideradas não adequadas, tendo em vista a indicação e o tempo de tratamento. Houve um alto percentual de inadequação na utilização de benzodiazepínicos, principalmente pelo uso prolongado e para atender a casos considerados pelos prescritores como uso crônico/dependência. Assim, há responsabilidade do serviço de saúde na manutenção da dependência.
Collapse
|
8
|
Firmino KF, Abreu MHNGD, Perini E, Magalhães SMS. Fatores associados ao uso de benzodiazepínicos no serviço municipal de saúde da cidade de Coronel Fabriciano, Minas Gerais, Brasil. CAD SAUDE PUBLICA 2011; 27:1223-32. [DOI: 10.1590/s0102-311x2011000600019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 04/26/2011] [Indexed: 11/21/2022] Open
Abstract
O uso inadequado de benzodiazepínicos é observado em diversos países. Este estudo transversal avaliou os fatores associados à prescrição de benzodiazepínicos para os usuários do Serviço Municipal de Saúde de Coronel Fabriciano, Minas Gerais, Brasil. A coleta de dados foi feita a partir da notificação das receitas (n = 1.866), entre setembro e outubro de 2006. Análises bivariada e multivariada, utilizando regressão de Poisson, foram executadas. O uso prolongado de benzodiazepínicos foi associado independentemente com o tipo de benzodiazepínico prescrito e cadastro em programas de saúde. O uso concomitante de outros psicofármacos foi associado independentemente com a idade e cadastro nos programas de saúde. O tipo de benzodiazepínico utilizado (Diazepam ou Clonazepam) esteve independentemente associado com a idade e sexo dos pacientes, bem como, com a participação em programas de saúde. Os fatores associados à prescrição de benzodiazepínicos evidenciam a amplitude do problema e devem ser considerados no planejamento de intervenções para a racionalização da utilização desses medicamentos no município, particularmente na organização dos programas de saúde.
Collapse
|
9
|
Dièye AM, Sy AN, Sy GY, Diallo AA, Diarra M, Ndiaye M, Faye B. [Prescription of benzodiazepines by general practitioners in the private sector of Dakar: survey on knowledge and attitudes]. Therapie 2007; 62:163-8. [PMID: 17582318 DOI: 10.2515/therapie:2007018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate knowledge and attitudes of general practitioners of the private sector, in Dakar, concerning prescription of benzodiazepines, in order to make, possibly, recommendations for their rational use. METHOD A survey was done in 2005 with a representative sample of 55 medical doctors. Medical doctors filled in the questionnaire which focused on the main benzodiazepines' indications, those prescribed and their rules of prescription. RESULTS The main indications were anxiety, convulsions, epilepsy and insomnia and the benzodiazepines prescribed in first intention were prazepam against anxiety and insomnia and diazepam against convulsions and epilepsy. Practically 17% of medical doctors ignored the existence of limited period of benzodiazepine use and 70.9% of medical doctors considered their training on benzodiazepines insufficient. CONCLUSION These results show the necessity to base continuous training for these general practitioners on the pharmacology of benzodiazepines.
Collapse
Affiliation(s)
- Amadou Moctar Dièye
- Laboratoire de Pharmacologie, Faculté de Médecine, de Pharmacie et d'Odonto-Stomatologie, Université Cheikh Anta Diop de Dakar, Dakar-Fann, Sénégal
| | | | | | | | | | | | | |
Collapse
|