Medicines dispensing practice during the era of COVID-19 pandemic: a commentary

Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia

BACKGROUND

Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia.

METHODS

Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action.

RESULTS

The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members.

CONCLUSION

This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).

Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia

BACKGROUND

Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia.

METHODS

A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance.

FINDINGS

The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation.

CONCLUSIONS

Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.

Exploring the barriers, facilitators, and opportunities to enhance uptake of sexual and reproductive health, HIV and GBV services among adolescent girls and young women in Zambia: a qualitative study

INTRODUCTION

Adolescents and young women in low-middle-income countries face obstacles to accessing HIV, Sexual and Reproductive Health (SRH), and related Gender-Based Violence (GBV) services. This paper presents facilitators, opportunities, and barriers to enhance uptake of HIV, GBV, and SRH services among Adolescent Girls and Young Women (AGYW) in selected districts in Zambia.

METHODS

This study was conducted in Chongwe, Mazabuka, and Mongu Districts among adolescent girls and young women in Zambia. Key informants (n = 29) and in and out-of-school adolescents and young people (n = 25) were interviewed. Purposive sampling was used to select and recruit the study participants. Interviews were transcribed verbatim, and a content analysis approach was used for analysis.

RESULTS

The facilitators that were used to enhance the uptake of services included having access to health education information on comprehensive adolescent HIV and gender-based violence services. Non-governmental organisations (NGOs) were the main source of this information. The opportunities bordered on the availability of integrated approaches to service delivery and strengthened community and health center linkages with referrals for specialised services. However, the researchers noted some barriers at individual, community, and health system levels. Refusal or delay to seek the services, fear of side effects associated with contraceptives, and long distance to the health facility affected the uptake of services. Social stigma and cultural beliefs also influenced the understanding and use of the available services in the community. Health systems barriers were; inadequate infrastructure, low staffing levels, limited capacity of staff to provide all the services, age and gender of providers, and lack of commodities and specialised services.

CONCLUSION

The researchers acknowledge facilitators and opportunities that enhance the uptake of HIV, GBV, and SRH services. However, failure to address barriers at the individual and health systems level always negatively impacts the uptake of known and effective interventions. They propose that programme managers exploit the identified opportunities to enhance uptake of these services for the young population.

Building a resilient health system for universal health coverage and health security: a systematic review

BACKGROUND

Resilient health system (RHS) is crucial to achieving universal health coverage (UHC) and health security. However, little is known about strategies towards RHS to improve UHC and health security. This systematic review aims to synthesise the literature to understand approaches to build RHS toward UHC and health security.

METHODS

A systematic search was conducted including studies published from 01 January 2000 to 31 December 2021. Studies were searched in three databases (PubMed, Embase, and Scopus) using search terms under four domains: resilience, health system, universal health coverage, and health security. We critically appraised articles using Rees and colleagues' quality appraisal checklist to assess the quality of papers. A systematic narrative synthesis was conducted to analyse and synthesise the data using the World Health Organization's health systems building block framework.

RESULTS

A total of 57 articles were included in the final review. Context-based redistribution of health workers, task-shifting policy, and results-based health financing policy helped to build RHS. High political commitment, community-based response planning, and multi-sectorial collaboration were critical to realising UHC and health security. On the contrary, lack of access, non-responsive, inequitable healthcare services, poor surveillance, weak leadership, and income inequalities were the constraints to achieving UHC and health security. In addition, the lack of basic healthcare infrastructures, inadequately skilled health workforces, absence of clear government policy, lack of clarity of stakeholder roles, and uneven distribution of health facilities and health workers were the challenges to achieving UHC and health security.

CONCLUSIONS

Advanced healthcare infrastructures and adequate number of healthcare workers are essential to achieving UHC and health security. However, they are not alone adequate to protect the health system from potential failure. Context-specific redistribution of health workers, task-shifting, result-based health financing policies, and integrated and multi-sectoral approaches, based on the principles of primary health care, are necessary for building RHS toward UHC and health security.

Impact of pharmacist interventions on immunisation uptake: a systematic review and meta-analysis

Background

Under-utilisation of immunisation services remains a public health challenge. Pharmacists act as facilitators and increasingly as immunisers, yet relatively little robust evidence exists of the impact elicited on patient health outcome and vaccination uptake.

Objective

To evaluate the influence of pharmacist interventions on public vaccination rate.

Methods

SCOPUS, PubMed, and Web of Science were searched from inception to April 2023 to retrieve non- and randomised controlled clinical trials (RCTs). Studies were excluded if no comparator group to pharmacist involvement was reported. Data extraction, risk of bias assessments, and meta-analyses using random-effect models, were performed.

Results

Four RCTs and 15 non-RCTs, encompassing influenza, pneumococcal, herpes zoster, and tetanus-diphtheria and pertussis vaccine types, and administered in diverse settings including community pharmacies, were included. Pooled effect sizes revealed that, as compared to usual care, pharmacists, regardless of their intervention, improved the overall immunisation uptake by up to 51% [RR 1.51 (1.28, 1.77)] while immunisation frequency doubled when pharmacists acted specifically as advocators [RR 2.09 (1.42, 3.07)].

Conclusion

While the evidence for pharmacist immunisers was mixed, their contribution to immunisation programmes boosted public vaccination rate. Pharmacists demonstrated leadership and acquired indispensable advocator roles in the community and hospital settings. Future research could explore the depth of engagement and hence the extent of influence on immunisation uptake.

Effects of COVID-19 on sexual and reproductive health services access in the Asia-Pacific region: a qualitative study of expert and policymaker perspectives

The COVID-19 pandemic has strained health systems globally, with governments imposing strict distancing and movement restrictions. Little is known about the effects of the COVID-19 pandemic on sexual and reproductive health (SRH). This study examined perceived effects of COVID-19 on SRH service provision and use in the Asia-Pacific region. We conducted a qualitative study using semi-structured interviews with 28 purposively sampled SRH experts in 12 Asia-Pacific countries (e.g. United Nations, international and national non-governmental organisations, ministries of health, academia) between November 2020 and January 2021. We analysed data using the six-stage thematic analysis approach proposed by Braun and Clarke (2019). Interviewees reported that COVID-19 mitigation measures, such as transport restrictions and those that decreased the availability of personal protective equipment (PPE), reduced SRH service provision and use in most countries. SRH needs related to service barriers and gender-based violence increased. Systemic challenges included fragmented COVID-19 response plans and insufficient communication and collaboration, particularly between public and private sectors. SRH service-delivery challenges included COVID-19 response prioritisation, e.g. SRH staff task-shifting to COVID-19 screening and contact tracing, and lack of necessary supplies and equipment. Innovative SRH delivery responses included door-to-door antenatal care and family planning provision in the Philippines, online platforms for SRH education and outreach in Viet Nam, and increasing SRH service engagement through social media in Myanmar and Indonesia. To ensure continuation of SRH services during health emergencies, governments should earmark human and financial resources and prioritise frontline health-worker safety; work with communities and the private sector; and develop effective risk communications.

Assessment of Availability of Tracer Drugs and Basic Diagnostics at Public Primary Health Care Facilities in Ethiopia During COVID-19 Pandemic

Background

The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia.

Methods

Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented.

Results

The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy.

Conclusion

This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis

BACKGROUND

Comprehensive sexuality education (CSE) has recently become salient, but adolescent sexual reproductive health and rights (ASRHR) challenges are still a global health problem. Studying policies which have implications for CSE implementation is a crucial but neglected issue, especially in low and middle-income countries (LMICs) like Zambia. We analyzed policy synergies, challenges and contradictions influencing implementation of CSE framework in Zambia.

METHODS

We conducted a document review and qualitative interviews with key stakeholders from Non-Governmental Organizations, as well as health and education ministries at the National and all (10) provincial headquarters. Our methods allowed us to capture valuable insights into the synergies, challenges and contradictions that exist in promoting CSE framework in Zambia.

RESULTS

The study highlighted the synergies between policies that create opportunities for implementation of CSE through the policy window for adoption of sexual reproductive health and rights (SRHR) that opened around the 1990s in Zambia, promotion of inclusive development via education, adoption of an integrated approach in dealing with SRHR problems, and criminalization of gender-based violence (GBV). This analysis also identified the policy challenges and contradictions including restricted delivery of education on contraception in schools; defining childhood: dual legal controversies and implications for children, grey zones on the minimum age to access SRHR services; inadequate disability inclusiveness in SRHR legal frameworks; policy silences/contentious topics: LGBTQI + rights, abortion, and grey zones on the minimum age to access SRHR services.

CONCLUSION

While many policies support the implementation of CSE in schools, the existence of policy silences and challenges are among the barriers affecting CSE implementation. Thus, policy reformulation is required to address policy silences and challenges to enhance effective promotion and integration of the CSE framework.

BACKSLIDING ON CHILDHOOD IMMUNIZATIONS DUE TO ONGOING COVID-19 PANDEMIC: A RETROSPECTIVE STUDY IN BANADIR REGION, SOMALIA

Background

SARS-CoV-2 has resulted in a global public health crisis. During the pandemic, considerable delay was observed making it impossible for some children to receive their due vaccines on time. Like most resource-poor countries, COVID-19 pandemic is thought to have a negative impact on Somalia's immunization coverage.

Materials and methods

This study aimed to assess the impact of the COVID-19 pandemic on routine childhood immunization coverage in Somalia. A retrospective comparative cross-sectional approach was employed to investigate the number of under-5-year children who got their immunization from the two major mother and child hospital, (Banadir and SOS hospitals) in Mogadishu, Somalia from October 2019 to December 2020. To do this, a total of 112, 060 data relating to the routine childhood immunization (measles, polio, whooping cough, hepatitis B, pneumonia, and tuberculosis) were collected from the monthly immunization report-data from the two hospitals.

Results

The results showed that all the vaccines except birth vaccines have remarkably dropped with Penta-3 (27%), Penta-2 (11%), measles (10%) and Penta-1 (8%) respectively. However, the birth vaccines (BCG and Polio 0) were not affected as observed in this study. The reduction in children immunization rate in Somalia may be a combination of many other factors, we however recognize that the COVID-19 pandemic may have contributed significantly to this outcome .

Conclusion

The government needed to take proactive measures to encourage parents to present their children for immunizations, including increasing community awareness concerning the importance of these routine childhood immunizations despite the ongoing COVID-19 pandemics.

Libido-sexual disorders and abandonment of injectable contraceptives among users of the Ivorian Association for Family Well-Being in Korhogo, Côte d'Ivoire

Introduction

The recent introduction of modern contraceptive methods in resource-limited countries is confronted with the occurrence of undesirable effects that hinder their use in the long term. This study conducted among the users of the Ivorian Association for Family Well-Being in Korhogo describes the libido-sexual problems associated with the discontinuation of injectable contraceptives in former users. The objective of the study was to identify the factors that led to the abandonment of injectable contraceptives among female users of the Ivorian Association for Family Well-Being in Korhogo between 2018 and 2019.

Materials and methods

Qualitative data were collected from 15 former users (24-38 years old) of injectable contraceptives duration of 2-3 months. Additional data were collected from five health workers aged 35-60 years. In-depth interviews were conducted to explore the experience with injectable contraceptives and reasons for discontinuation. Following data collection, audio-recorded data were transcribed, translated, and coded using thematic analysis through an inductive approach.

Results

Side effects identified as associated with injectable contraceptives include libido-sexual disorders, unusual bleeding, and weight gain. The most common reason for discontinuation were libido-sexual disorders, which impacted the households' intimacy and provoked their abandonment or the change of contraceptive methods among injectable contraceptive users.

Conclusion

Adverse events were dominated by libido-sexual disorders, unusual bleeding, and weight gain leading to the abandonment or change of the contraceptive. These results suggest points of intervention for increasing continuation among users. This intervention should include training of health workers to investigate and manage adverse events related to the use of injectable contraceptives and the improvement of communication between health workers and users on adverse events of injectable contraceptive use.

Pharmacy education and workforce: strategic recommendations based on expert consensus in Lebanon

Pharmacy in Lebanon has been taught for years, and the profession has known the golden ages in previous years. However, with the recent graduation of hundreds of pharmacists, without prior workforce planning, the oversupply of non-specialized pharmacists caused a mismatch with the needs of the market. The context of severe socioeconomic and sanitary crises has further exacerbated the situation, with hundreds of pharmacists leaving the country. A group of pharmacy experts joined to suggest strategic solutions to face such challenges, suggesting a clear strategy for education and the workforce, overarched by educational and professional values and based on six main pillars: (1) implement a national competency framework (including the core and specialized competency frameworks) to be used as a basis for licensure (colloquium); (2) implement a national pharmacy program accreditation, encompassing standards related to competencies adoption and assessment, curricula, teaching methods, research and innovation, instructors' and preceptors' skills, and experiential training; (3) organize training for students and early-career pharmacists; (4) optimize continuing education and implement continuous professional development, fostering innovation and specialization among working pharmacists; (5) develop and implement a pharmacy workforce strategy based on pharmacy intelligence, job market, and academic capacities; (6) develop and implement a legal framework for the above-mentioned pillars in collaboration with ministries and parliamentary commissions. Under the auspices of the relevant authorities, mainly the Order of Pharmacists of Lebanon and the Ministry of Education and Higher Education, the suggested strategy should be discussed and implemented for a better future for the pharmacy profession.

Impact of the COVID-19 pandemic on dispensing medicines in the community pharmacy

BACKGROUND

The world has faced an unprecedented challenge since COVID-19 emerged as a pandemic, which has led to quarantine and disruptions in drug services. During the pandemic, drug use habits and availability changed, causing a shift in behaviors and, in turn, medicine misuse. In Iraq, this is a major problem because many medicines can be easily obtained.

OBJECTIVE

The study aims to describe the pattern of dispensing medications during the pandemic and to evaluate the biochemical and pathological consequences.

METHOD

The analytical, observational, cross-sectional study was performed via a compiled questionnaire for 400 random pharmacists, and the analysis and interpretation of the biochemical changes and medical reports.

RESULTS

Results revealed that dispensing of medications since the COVID-19 outbreak has increased by 74%, and the demand for medicines seems higher than required in comparison to the periods before the pandemic, while 60% of the dispensed medicines were taken just in case needed. In addition, the availability of medicines decreased by 61%, and the dispensing of common medicines increased due to the belief in their prophylactic action. Several biochemical abnormalities and pathological consequences were recorded due to the irrational use of medicines, and the highest percentage (12%) was seen in hepatic and liver enzymatic dysfunction and 8% for the endocrine and hormonal abnormalities.

CONCLUSION

It can be concluded that most of the dispensed medicines were not used on a therapeutic or scientific basis during the pandemic.

Prevalence and associated factors of medication-related problems among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: a cross-sectional study

Background

Despite appropriate treatment of epilepsy, the treatment outcome is poor in developing country. Therefore, the study was aimed to identify the magnitude and associated factors of epileptic patients at ambulatory clinic of south western Ethiopian hospital.

Methods

A hospital-based cross-sectional study was conducted on epileptic patients who had follow-up at Mettu Karl Comprehensive Specialized Hospital (MKCSH). Data collection was done through patient interview and medical charts review. The pharmaceutical care network Europe foundation classification system was used to assess the drug therapy problem and Naranjo algorithm of adverse drug reaction was employed to identify the probability of adverse drug reaction. The data were analyzed by SPSS version 23 after data were entered by Epidemiological Information (Epi Info) 7.2.1. The multivariable logistic regressions were utilized and P < 0.05 was used to declare association.

Results

Over the study period, more than half of the participants 172(57.7%) were males. The magnitude of drug-related problems was found to be 164(55.0%). Among epileptic patients about 323 drug-related problems (DRPs) were identified on average, 1.084 drug-related problems (DRPs) per patient. The widely occurred types of drug-related problems were needs additional drug therapy 72(22.29%), dose too low 52(16.09%) and dose to high which accounts 50(15.48%). Regarding the predictors of drug-related problems, being a female (AOR = 3.57, 95% CI:1.85–6.88, P ≤ 0.001), having frequent seizures (AOR = 2.47, 95% CI%:1.33–4.61, P = 0.004) and the presence of poly-pharmacy (AOR = 3.57, 95% CI: 1.49–8.5, P = 0.004) were predictors of drug-related problems.

Conclusion

More than half of the patients had a drug therapy problem. Number of medications taken by the patients, gender and the seizure frequency had a significant association with occurrence of drug therapy problems (DTPs). Therefore, the pharmaceutical care in general and drug information services in particular should be established to hinder any undesirable medication effects in our study area.

Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review

BACKGROUND

Comprehensive sexuality education (CSE) plays a critical role in promoting youth and adolescent's sexual and reproductive health and wellbeing. However, little is known about the enablers and barriers affecting the integration of CSE into educational programmes. The aim of this review is to explore positive and negative factors influencing the integration of CSE into national curricula and educational systems in low- and middle-income countries.

METHODS

We conducted a systematic literature review (January 2010 to August 2022). The results accord with the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards for systematic reviews. Data were retrieved from the PubMed, Cochrane, Google Scholar, and Web of Hinari databases. The search yielded 442 publications, of which 34 met the inclusion criteria for full-text screening. The review is guided by an established conceptual framework that incorporates the integration of health innovations into health systems. Data were analysed using a thematic synthesis approach.

RESULTS

The magnitude of the problem is evidenced by sexual and reproductive health challenges such as high teenage pregnancies, early marriages, and sexually transmitted infections. Awareness of these challenges can facilitate the development of interventions and the implementation and integration of CSE. Reported aspects of the interventions include core CSE content, delivery methods, training materials and resources, and various teacher-training factors. Reasons for adoption include perceived benefits of CSE, experiences and characteristics of both teachers and learners, and religious, social and cultural factors. Broad system characteristics include strengthening links between schools and health facilities, school and community-based collaboration, coordination of CSE implementation, and the monitoring and evaluation of CSE. Ultimately, the availability of resources, national policies and laws, international agendas, and political commitment will impact upon the extent and level of integration.

CONCLUSION

Social, economic, cultural, political, legal, and financial contextual factors influence the implementation and integration of CSE into national curricula and educational systems. Stakeholder collaboration and involvement in the design and appropriateness of interventions is critical.

Practical approaches to improve vancomycin-related patient outcomes in pediatrics- an alternative strategy when AUC/MIC is not feasible

BACKGROUND

Anecdotal experience and studies have shown that most pediatric patients fail to reach target therapeutic vancomycin trough levels (VTLs) and required higher total daily doses (TDD). This retrospective study aims to evaluate the frequency of hospitalized children who achieved target VTLs with a vancomycin (VNCO) dosing regimen of 40-60 mg/kg/d q6h and to assess the VNCO-TDD required to attain the target and their effects on clinical outcomes in pediatric patients.

METHODS

After ethical approval, patients of 3 month-12 years were evaluated in this chart review study who received ≥ 3 intravenous-VNCO doses and appropriately drawn blood samples of VTLs between October 2019 to June 2020. Data were retrieved for demographic and clinical characteristics, culture reports, VNCO-regimen, subsequent steady-state VTLs, concomitant nephrotoxic medications, and serum creatinine. Clinical pharmacists made interventions in VNCO therapy and higher VNCO-TDD were used. Safety of higher vs standard daily doses and their clinical impact on duration of therapy, hospital stay, and survival were evaluated.

RESULTS

A total of 89 (39.1%) patients achieved target VTLs (SD-group). The smallest proportion (18.2%) of 2-6 years patients achieved target VTLs and reported the lowest mean value of 10.1 ± 0.2 mg/L which was a significant difference (p < 0.05) from all subgroups. Subtherapeutic VTLs were observed in 139 (60.9%) cases (HD-group), who received higher VNCO-TDD of 72 ± 8.9 mg/kg/d q6h to achieve the targets. Duration of therapy in culture-proven septic patients was significantly (p = 0.025) longer in SD-group [18.4 ± 12.2 days] than HD-group [15.1 ± 8.9 days]. Nephrotoxicity and electrolyte imbalance were comparable in groups. Length of hospital stay was significantly (p = 0.011) longer [median 22 (range 8-55) days] in SD-group compared to HD-group [median 16 (range 8-37) days]. Number of patients survived in HD-group were significantly (p = 0.008) higher than SD-group [129 (92.8%) vs 75 (84.3%)].

CONCLUSION

Initial Vancomycin doses of 72 ± 8.9 mg/kg/day q6h are required to achieve therapeutic target in 3 months to 12 years patients. High doses are not associated with higher nephrotoxicity than reported with low doses. In addition, efficient pharmacist intervention for the use of higher VNCO-TDD may improve clinical outcomes in terms of duration of therapy, hospital stay, and survival.

Real-World Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies During the COVID-19 Pandemic

OBJECTIVES

In Portugal, the dispensing of most outpatient specialty medicines is performed exclusively through hospital pharmacies and totally financed by the National Health Service. During the COVID-19 first wave, the government allowed the transfer of the dispensing of hospital-only medicines (HOMs) to community pharmacies (CPs). This study aimed to measure the value generated by the intervention of CP in the dispensing of HOM.

METHODS

A single-arm, before-and-after study with 3-month follow-up was conducted enrolling a randomly selected sample of patients or caregivers with at least 1 dispensation of HOM through CP. Data were collected by telephone interview. Main outcomes were patients' self-reported adherence (Measure Treatment Adherence), health-related quality of life (EQ-5D 3-Level), satisfaction with the service, and costs related to HOM access.

RESULTS

Overall 603 subjects were recruited to participate in the study (males 50.6%) with mean 55 years old (SD = 16). The already high mean adherence score to therapy improved significantly (P < .0001), and no statistically significant change (P > .5757) was found in the mean EQ-5D score between baseline (0.7 ± 0.3) and 3-month follow-up (0.8 ± 0.3). Annual savings account for €262.1/person, arising from travel expenses and absenteeism reduction. Participants reported a significant increase in satisfaction levels in all evaluated domains-pharmacist's availability, opening hours, waiting time, privacy conditions, and overall experience.

CONCLUSIONS

Changing the dispense setting to CP may promote better access and satisfaction. Moreover, it ensures the persistence of treatments, promotes savings for citizens, and reduces the burden of healthcare services, representing a crucial public health measure.

The modern Russian pharmaceutical market: consumer attitudes towards distance retailing of medicines

Background

In Russia, remote retail trade of over-the-counter (OTC) medicines was legalised. According to statistics as of April 2020, consumer demand in the categories of “online pharmacies” increased by 803%.

Methods

The study was conducted in two stages by cross-sectional method using a structured questionnaire in the central region of Russia: 1st stage - July-August 2020; 2nd stage - February-March 2021. The results of the study were obtained using qualitative (method of discussions in focus groups) and quantitative methods (survey) of sociological research, logical and statistical analysis. The representativeness of the data was ensured by a sufficient sample size including 1194 consumers (with confidence probability = 0.95 and confidence interval ≤ 0.05).

Results

The number of respondents fully supporting the legalisation of online trade in medicines increased. Consumer attitudes towards online commerce depend on the age group of the respondents. 1.5 times more respondents over 46 years (12.1%) are strongly against distance selling of medicines compared to survey participants aged 18 to 25 years (7.8%). Six months after the first survey, no respondent strongly opposed the sale of prescription medicines through the internet, whereas in the first survey half of consumers held this view. The percentage of respondents who considered pharmaceutical counselling when purchasing medicines online as extremely important decreased by a factor of 4 over time (10.9%) M (08.2020) = 3.66 (0.992); M (03. 2021) = 3.17 (0.981) t = 7.66 (p < 0.05). Consumers consider accessibility for people with disabilities (80.3%) to be the most significant advantage of distance selling medicines.

Conclusion

Consumer demand for the purchase of medicines online will grow as this type of sale has undeniable advantages. However, some risks remain when buying medicines online.

Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening

BACKGROUND

The health supply chain system is essential for the optimum performance of the healthcare system. Despite increased investments in the health supply chain system, access to quality Essential Medicines and Health Supplies remain a big challenge in Uganda. This article discusses the structure, performance, and challenges of the health supply chain system in Uganda. It provides reflections and implications for ongoing interventions for system strengthening.

DISCUSSIONS

The findings highlight several issues and challenges affecting the health supply chain system from functioning optimally across all levels of the health system. The challenges identified include an ineffective structure to support planning, coordination and management, inadequate funding, shortage of skilled staff, weak regulatory and governance structures at national and sub-national levels, and slow adoption and use of Electronic Logistics Information Systems to support supply chain processes and functions. Overcoming these challenges will require greater investments to improve policy development and implementation, infrastructure, equipment and support systems, knowledge and skills of supply chain personnel, increased funding and improving governance and accountability.

The Effect of the COVID-19 Pandemic on the Social Inequalities of Health Care Use in Hungary: A Nationally Representative Cross-Sectional Study

Background: The social representation of restricted health care use during the COVID-19 pandemic has not been evaluated properly yet in Hungary. Objective: Our study aimed to quantify the effect of COVID-19 pandemic measures on general practitioner (GP) visits, specialist care, hospitalization, and cost-related prescription nonredemption (CRPNR) among adults, and to identify the social strata susceptible to the pandemic effect. Methods: This cross-sectional study was based on nationally representative data of 6611 (N_prepandemic = 5603 and N_pandemic = 1008) adults. Multivariable logistic regression models were applied to determine the sociodemographic and clinical factors influencing health care use by odds ratios (ORs) along with the corresponding 95% confidence intervals (CI). To identify the social strata susceptible to the pandemic effect, the interaction of the time of data collection with the level of education, marital status, and Roma ethnicity, was tested and described by iORs. Results: While the CRPNR did not change, the frequency of GP visits, specialist care, and hospitalization rates was remarkably reduced by 22.2%, 26.4%, and 6.7%, respectively, during the pandemic. Roma proved to be not specifically affected by the pandemic in any studied aspect, and the pandemic restructuring of health care impacted the social subgroups evenly with respect to hospital care. However, the pandemic effect was weaker among primary educated adults (iOR_{GP visits, high-school vs. primary-education} = 0.434; 95% CI 0.243–0.776, OR_{specialist visit, high-school vs. primary-education} = 0.598; 95% CI 0.364–0.985), and stronger among married adults (iOR_{GP visit, widowed vs. married} = 2.284; 95% CI 1.043–4.998, iOR_{specialist visit, widowed vs. married} = 1.915; 95% CI 1.157–3.168), on the frequency of GP visits and specialist visits. The prepandemic CRPNR inequality by the level of education was increased (iOR_{high-school vs. primary-education} = 0.236; 95% CI 0.075–0.743). Conclusion: Primary educated and widowed adults did not follow the general trend, and their prepandemic health care use was not reduced during the pandemic. This shows that although the management of pandemic health care use restrictions was implemented by not increasing social inequity, the drug availability for primary educated individuals could require more support.