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Stocker KJ, Tiemann A, Brunk KM, Agegnehu B, Buhlinger K, Amerine L, Roberts MC, McLaughlin JE, Clark SM, Rose R, Mekonnen B, Bhakta N, Fentie AM, Alexander TB, Ozawa S, Chargualaf M, Muluneh B. Processes and perceptions of chemotherapy supply chain in Ethiopia: A mixed-method study. J Oncol Pharm Pract 2023; 29:1555-1564. [PMID: 36303425 DOI: 10.1177/10781552221134254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND The impact and downstream effects of the chemotherapy supply chain in Ethiopia are not well understood. The purpose of this study was to identify perceived gaps in supply chain and characterize their impact on patient care. METHODS A concurrent mixed-method study was conducted at a large academic cancer center in Ethiopia. In-depth interviews (IDIs) and surveys were completed in collaboration with external stakeholders with knowledge about chemotherapy supply chain in Ethiopia. Thematic coding was used for qualitative analysis of IDI and descriptive statistics were used to summarize quantitative survey data. RESULTS Six stakeholders participated in the IDIs and seven completed surveys. IDIs revealed that most chemotherapeutic agents are purchased by the Ethiopian Pharmaceutical Supply Agency (EPSA) and are distributed to cancer treatment centers. A free-market purchasing option also exists, but for chemotherapy obtained outside of government-subsidized channels, the potential for substandard or falsified chemotherapy was a concern. Participants expressed confidence that the correct treatment was administered to patients, but viewpoints on reliability and consistency of medication supply were variable. Quantitative data from the survey showed that participants were not confident that medications are prepared safely and correctly. Improper storage and manipulation of high-risk medications remain a significant risk to staff. CONCLUSIONS This study provides insight from a healthcare staff perspective on how gaps in the chemotherapy supply chain process impact patient care in a low-income country. Inventory management, disruptions in supply chain, and product integrity were perceived as the largest gaps in the current chemotherapy supply chain structure.
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Affiliation(s)
- Kurtis J Stocker
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Andrew Tiemann
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Kelly M Brunk
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Bemnat Agegnehu
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Kaitlyn Buhlinger
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Lindsey Amerine
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Megan C Roberts
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Stephen M Clark
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Robert Rose
- Department of pharmacy, University of Kentucky HealthCare, Lexington, KY, USA
| | | | | | - Atalay Mulu Fentie
- Addis Ababa University, College of Health Sciences, School of Pharmacy, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Tikur Anbesa Specialized Hospital, Oncology Unit, Addis Ababa, Ethiopia
| | - Thomas B Alexander
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sachiko Ozawa
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Michael Chargualaf
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Benyam Muluneh
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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Buhlinger KM, Borlagdan J, Agegnehu B, Fentie AM, Bernstein AT, Urick BY, Roberts M, Weitzman S, Bekele W, Korones D, Alexander TB, Broas J, Shad A, Dinkiye AM, Clark SM, Adam H, Hailu D, Muluneh B. Results of a pre-implementation analysis of Ethiopia's National Pediatric Cancer Registry. J Oncol Pharm Pract 2020; 27:1940-1947. [PMID: 33342356 DOI: 10.1177/1078155220980051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Ethiopia, cancer accounts for about 5.8% of total national mortality, with an estimated annual incidence of cancer of approximately 60,960 cases and an annual mortality of over 44,000 persons. This is likely an underestimation. Survival rates for pediatric malignancies are likewise suboptimal although exact figures are unknown since a national cancer registry is unavailable. The World Health Organization (WHO) provides recommendations for the creation of cancer registries to track such data. Here we describe our pharmacist-led, pre-implementation assessment of introducing an enhanced national pediatric cancer registry in Ethiopia. Our assessment project had three specific aims around which the methods were designed: 1) characterization of the current spreadsheet-based tool across participating sites, including which variables were being collected, how these variables compared to standards set by the WHO, and a description of how the data were entered and its completeness; 2) assessment of the perceptions of an enhanced registry from hospital staff; and 3) evaluation of workflow gaps regarding documentation. The hospital staff and leadership have generally positive perceptions of an enhanced pediatric cancer registry, which were further improved by our interactions. The workflow assessment revealed several gaps, which were addressed systematically using a three-phase implementation science approach. The assessment also demonstrated that the existing spreadsheet-based tool was missing WHO-recommended variables and had inconsistent completion due to the workflow gaps. A pediatric oncology summary sheet will be implemented in upcoming trips in patient charts to better summarize the patients' journey starting from diagnosis. This document will be used by the data clerks in an enhanced-spreadsheet to have a more complete data set.
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Affiliation(s)
- Kaitlyn M Buhlinger
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.,University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jared Borlagdan
- Pharmacy Services, Oregon Health & Science University, Portland, OR, USA
| | | | - Atalay M Fentie
- Tikur Anbessa Specialty Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adam T Bernstein
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Benjamin Y Urick
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Megan Roberts
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Sheila Weitzman
- The Aslan Project, Washington, DC, USA.,The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - David Korones
- The Aslan Project, Washington, DC, USA.,Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas B Alexander
- The Aslan Project, Washington, DC, USA.,University of North Carolina, Lineberger Comprehensive Cancer Center
| | | | - Aziza Shad
- The Aslan Project, Washington, DC, USA.,Department of Pediatrics, Georgetown University Medical Center, Washington, DC, USA
| | - Ali Mamude Dinkiye
- Tikur Anbessa Specialty Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Stephen M Clark
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Hayleyesus Adam
- Tikur Anbessa Specialty Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Hailu
- Tikur Anbessa Specialty Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Benyam Muluneh
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.,University of North Carolina, Lineberger Comprehensive Cancer Center
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