A drug utilisation review of Isotretinoin in the management of acne
- Authors: Burger, Solé
- Date: 2007
- Subjects: Acne -- Treatment , Isotretinoin
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10147 , http://hdl.handle.net/10948/673 , Acne -- Treatment , Isotretinoin
- Description: Acne is a common, chronic disorder that affects many adolescents. The most effective acne medication is systemic isotretinoin. It provides a permanent cure for many patients, but has various side effects. A South African Acne Treatment Guideline was introduced in 2005. Adherence to this guideline could lead to safer, more effective acne management. The primary aim of this study was to investigate the appropriateness of medications prescribed in the treatment of acne in South Africa, and to evaluate the safety and efficacy of systemic isotretinoin utilised by patients in the Nelson Mandela Metropole (NMM). A drug utilisation study (including 18 803 South African acne patients’ chronic prescription data between 2000 and 2005) and a patient questionnaire survey (including information from 57 patients in the NMM who used systemic isotretinoin) were conducted. Basic descriptive and interferential statistics were calculated. The drug utilisation study revealed that systemic antibiotics were the acne treatment prescribed to most (43.3 percent) patients, followed by 42.1 percent of patients on systemic isotretinoin, 33.2 percent on hormonal therapy and 18.9 percent on topical therapy. Topical retinoids were underused. The questionnaire survey indicated a lack of compliance by prescribers with guideline recommendations regarding the prescription (and accompanying counselling and monitoring) of isotretinoin. Incorrect cumulative doses were frequently prescribed, and a lack of proper implementation of pregnancy prevention measures was evident. The majority of isotretinoin patients reported a high efficacy of isotretinoin in clearing their acne.
- Full Text:
- Date Issued: 2007
- Authors: Burger, Solé
- Date: 2007
- Subjects: Acne -- Treatment , Isotretinoin
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10147 , http://hdl.handle.net/10948/673 , Acne -- Treatment , Isotretinoin
- Description: Acne is a common, chronic disorder that affects many adolescents. The most effective acne medication is systemic isotretinoin. It provides a permanent cure for many patients, but has various side effects. A South African Acne Treatment Guideline was introduced in 2005. Adherence to this guideline could lead to safer, more effective acne management. The primary aim of this study was to investigate the appropriateness of medications prescribed in the treatment of acne in South Africa, and to evaluate the safety and efficacy of systemic isotretinoin utilised by patients in the Nelson Mandela Metropole (NMM). A drug utilisation study (including 18 803 South African acne patients’ chronic prescription data between 2000 and 2005) and a patient questionnaire survey (including information from 57 patients in the NMM who used systemic isotretinoin) were conducted. Basic descriptive and interferential statistics were calculated. The drug utilisation study revealed that systemic antibiotics were the acne treatment prescribed to most (43.3 percent) patients, followed by 42.1 percent of patients on systemic isotretinoin, 33.2 percent on hormonal therapy and 18.9 percent on topical therapy. Topical retinoids were underused. The questionnaire survey indicated a lack of compliance by prescribers with guideline recommendations regarding the prescription (and accompanying counselling and monitoring) of isotretinoin. Incorrect cumulative doses were frequently prescribed, and a lack of proper implementation of pregnancy prevention measures was evident. The majority of isotretinoin patients reported a high efficacy of isotretinoin in clearing their acne.
- Full Text:
- Date Issued: 2007
A proposed baseline South African antimicrobial stewardship curriculum for the Bachelor of Pharmacy programme
- Authors: Khan, Yasmine
- Date: 2019
- Subjects: Pharmacy -- Study and teaching -- South Africa , Pharmacy -- Practice -- South Africa Drug utilization -- Dissertations Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/35752 , vital:33805
- Description: Antimicrobial stewardship refers to the healthcare practice which ensures the judicious and appropriate prescribing of antimicrobial agents. The primary purpose of antimicrobial stewardship entails minimising the progression of antimicrobial resistance; the rise of which is recognised as a threat to global health and safety. The pharmacist is recognised nationally and internationally as a key role player in the implementation of antimicrobial stewardship. Education of healthcare practitioners in antimicrobial stewardship is a recognised strategic enabler for the containment of antimicrobial resistance in South Africa. The primary aim of the study was to develop a proposed baseline antimicrobial stewardship curriculum which is suitable for implementation into the Bachelor of Pharmacy programmes offered by South African schools of pharmacy. The aims and objectives of the study were achieved through the conduction of four study phases: the content analysis, academic review, expert consultation and curriculum development. The content analysis investigated the structure and content of international antimicrobial stewardship curricula, and the national policy governing antimicrobial stewardship implementation in South Africa. Frequency distributions of trends from the reviewed literature informed the development of the initial draft antimicrobial stewardship curriculum for pharmacy students. In terms of content, the principles which emerges with high frequency, which were thus emphasised in the initial draft curriculum, included: the strategic objectives (governance, surveillance, antimicrobial stewardship and infection prevention); strategic enablers (education, communication, legislation and research); dose optimisation; audit and feedback; formulary restriction; collaboration; pre-authorisation; and de-escalation. Available literature did not provide extensive detail regarding the curriculum structure utilised internationally, particularly with regards to the number of contact hours dedicated to the curriculum content and the year level at which antimicrobial stewardship was incorporated in the degree programme (variable between studies). From the content analysis it was evident that a mixed methods pedagogy and use of multiple assessment techniques were recommended. The academic review phase allowed for further insight to be obtained into the content and structure of antimicrobial stewardship curriculum content which was presented in the pre-existing Bachelor of Pharmacy degree programmes. Furthermore, the academic review required that nominated participants from each school of pharmacy indicate which antimicrobial prescribing principles should be incorporated in the proposed baseline antimicrobial stewardship curriculum. The results of the academic review phase were collated with the content analysis in order to develop the updated draft antimicrobial stewardship curriculum. It was interesting to note that large variation in content and structure related to antimicrobial stewardship which was presented by the various schools of pharmacy in South Africa. In terms of curriculum content, recommendations made by academic professionals informed the development of relative importance groupings, which allowed for the various antimicrobial stewardship principles to be tiered according to importance for inclusion in the proposed baseline antimicrobial stewardship curriculum. The large variation in antimicrobial stewardship curriculum structure posed as a challenge for the development of the proposed baseline curriculum, requiring that the structure remain flexible in order for feasible incorporation into the pre-existing Bachelor of Pharmacy degree programmes offered by the various schools of pharmacy in South Africa. The expert consultation phase explored the perceptions of multiple key health disciplines who serve as part of antimicrobial stewardship teams in South Africa with regards to the role of the pharmacist in antimicrobial stewardship; and the minimum level of antimicrobial stewardship knowledge and skills which pharmacy students should possess prior to entry into practice. The results of the expert consultation phase were collated with the results of the content analysis and academic review phase in order to develop the final proposed baseline antimicrobial stewardship curriculum. The findings of the expert consultation phase indicated great variability regarding the perceived role of the pharmacist in antimicrobial stewardship within and between health disciplines. Furthermore, the relative perceived importance of various antimicrobial stewardship strategies and antimicrobial prescribing principles were explored, which informed the tiering of content in the final proposed antimicrobial stewardship curriculum.
- Full Text:
- Date Issued: 2019
- Authors: Khan, Yasmine
- Date: 2019
- Subjects: Pharmacy -- Study and teaching -- South Africa , Pharmacy -- Practice -- South Africa Drug utilization -- Dissertations Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/35752 , vital:33805
- Description: Antimicrobial stewardship refers to the healthcare practice which ensures the judicious and appropriate prescribing of antimicrobial agents. The primary purpose of antimicrobial stewardship entails minimising the progression of antimicrobial resistance; the rise of which is recognised as a threat to global health and safety. The pharmacist is recognised nationally and internationally as a key role player in the implementation of antimicrobial stewardship. Education of healthcare practitioners in antimicrobial stewardship is a recognised strategic enabler for the containment of antimicrobial resistance in South Africa. The primary aim of the study was to develop a proposed baseline antimicrobial stewardship curriculum which is suitable for implementation into the Bachelor of Pharmacy programmes offered by South African schools of pharmacy. The aims and objectives of the study were achieved through the conduction of four study phases: the content analysis, academic review, expert consultation and curriculum development. The content analysis investigated the structure and content of international antimicrobial stewardship curricula, and the national policy governing antimicrobial stewardship implementation in South Africa. Frequency distributions of trends from the reviewed literature informed the development of the initial draft antimicrobial stewardship curriculum for pharmacy students. In terms of content, the principles which emerges with high frequency, which were thus emphasised in the initial draft curriculum, included: the strategic objectives (governance, surveillance, antimicrobial stewardship and infection prevention); strategic enablers (education, communication, legislation and research); dose optimisation; audit and feedback; formulary restriction; collaboration; pre-authorisation; and de-escalation. Available literature did not provide extensive detail regarding the curriculum structure utilised internationally, particularly with regards to the number of contact hours dedicated to the curriculum content and the year level at which antimicrobial stewardship was incorporated in the degree programme (variable between studies). From the content analysis it was evident that a mixed methods pedagogy and use of multiple assessment techniques were recommended. The academic review phase allowed for further insight to be obtained into the content and structure of antimicrobial stewardship curriculum content which was presented in the pre-existing Bachelor of Pharmacy degree programmes. Furthermore, the academic review required that nominated participants from each school of pharmacy indicate which antimicrobial prescribing principles should be incorporated in the proposed baseline antimicrobial stewardship curriculum. The results of the academic review phase were collated with the content analysis in order to develop the updated draft antimicrobial stewardship curriculum. It was interesting to note that large variation in content and structure related to antimicrobial stewardship which was presented by the various schools of pharmacy in South Africa. In terms of curriculum content, recommendations made by academic professionals informed the development of relative importance groupings, which allowed for the various antimicrobial stewardship principles to be tiered according to importance for inclusion in the proposed baseline antimicrobial stewardship curriculum. The large variation in antimicrobial stewardship curriculum structure posed as a challenge for the development of the proposed baseline curriculum, requiring that the structure remain flexible in order for feasible incorporation into the pre-existing Bachelor of Pharmacy degree programmes offered by the various schools of pharmacy in South Africa. The expert consultation phase explored the perceptions of multiple key health disciplines who serve as part of antimicrobial stewardship teams in South Africa with regards to the role of the pharmacist in antimicrobial stewardship; and the minimum level of antimicrobial stewardship knowledge and skills which pharmacy students should possess prior to entry into practice. The results of the expert consultation phase were collated with the results of the content analysis and academic review phase in order to develop the final proposed baseline antimicrobial stewardship curriculum. The findings of the expert consultation phase indicated great variability regarding the perceived role of the pharmacist in antimicrobial stewardship within and between health disciplines. Furthermore, the relative perceived importance of various antimicrobial stewardship strategies and antimicrobial prescribing principles were explored, which informed the tiering of content in the final proposed antimicrobial stewardship curriculum.
- Full Text:
- Date Issued: 2019
Antibiotic stewardship: the role of clinical pharmacist
- Authors: Ramkhalawon, Shabeerah
- Date: 2015
- Subjects: Hospital pharmacies -- South Africa Pharmacists -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/10858 , vital:26830
- Description: South Africa has a high prevalence of infectious diseases; the major ones being the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome epidemic, and tuberculosis. South Africa’s burden of resistant bacteria is also increasing. Antibiotic resistance in hospitalised patients leads to an increase in morbidity and mortality, resulting in longer hospital stays, and an increase in hospital costs. In order to counteract the problem of antibiotic resistance in hospitals and other healthcare facilities and preserve the efficacy of currently available antibiotics, there is a need for serious antibiotic management. Antibiotic stewardship initiatives have thus been put in place to guide healthcare professionals on the correct use of antibiotics. Clinical pharmacists can intervene and contribute to antibiotic stewardship owing to comprehensive knowledge of antibiotics, including the properties, uses, safety and efficacy of individual agents. There is a paucity of research to support the role of the clinical pharmacist in antibiotic stewardship in public sector hospitals. The current pharmacist staffing system within public sector hospitals does not adequately support pharmacists, in particular clinical pharmacists, to participate actively in antibiotic stewardship. The primary aim of the study was to evaluate the role of the clinical pharmacist in antibiotic stewardship in a public hospital setting. A secondary aim was to contribute towards more rational inpatient use of antibiotics in the general medical ward. The hypothesis for the study was that clinical pharmacists can make a positive contribution to the correct use of antibiotics in a public hospital setting. The study showed that the introduction of a pharmacist-driven antibiotic stewardship in the ward, using a prospective audit and feedback strategy, had a positive effect on overall appropriateness of antibiotic prescribing (Chi2=7.89; df=3; p=0.04815, Cramer’s V=0.13). However, this finding did not show any reduction in the volume of antibiotic use. Positive patient outcomes were achieved and shown through a reduction in the length of hospital stay (p=0.00487; one-way ANOVA). Although patients were not followed up on discharge to assess re-admission rates, the results are relevant in order to inform the hospital staff about the implementation of antibiotic stewardship at the public hospital setting with the aims of reducing inappropriate antibiotic prescribing and improving patient outcomes. From the results of the study, it can be concluded that the hypothesis was achieved and that the clinical pharmacist did play an integral role in antibiotic prescribing at the public hospital setting. Thus, it can be concluded that the study, though limited in its scope, achieved its aims and objectives, and showed that the clinical pharmacist does play an integral role in the rational use of antibiotics in a public hospital setting.
- Full Text:
- Date Issued: 2015
- Authors: Ramkhalawon, Shabeerah
- Date: 2015
- Subjects: Hospital pharmacies -- South Africa Pharmacists -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/10858 , vital:26830
- Description: South Africa has a high prevalence of infectious diseases; the major ones being the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome epidemic, and tuberculosis. South Africa’s burden of resistant bacteria is also increasing. Antibiotic resistance in hospitalised patients leads to an increase in morbidity and mortality, resulting in longer hospital stays, and an increase in hospital costs. In order to counteract the problem of antibiotic resistance in hospitals and other healthcare facilities and preserve the efficacy of currently available antibiotics, there is a need for serious antibiotic management. Antibiotic stewardship initiatives have thus been put in place to guide healthcare professionals on the correct use of antibiotics. Clinical pharmacists can intervene and contribute to antibiotic stewardship owing to comprehensive knowledge of antibiotics, including the properties, uses, safety and efficacy of individual agents. There is a paucity of research to support the role of the clinical pharmacist in antibiotic stewardship in public sector hospitals. The current pharmacist staffing system within public sector hospitals does not adequately support pharmacists, in particular clinical pharmacists, to participate actively in antibiotic stewardship. The primary aim of the study was to evaluate the role of the clinical pharmacist in antibiotic stewardship in a public hospital setting. A secondary aim was to contribute towards more rational inpatient use of antibiotics in the general medical ward. The hypothesis for the study was that clinical pharmacists can make a positive contribution to the correct use of antibiotics in a public hospital setting. The study showed that the introduction of a pharmacist-driven antibiotic stewardship in the ward, using a prospective audit and feedback strategy, had a positive effect on overall appropriateness of antibiotic prescribing (Chi2=7.89; df=3; p=0.04815, Cramer’s V=0.13). However, this finding did not show any reduction in the volume of antibiotic use. Positive patient outcomes were achieved and shown through a reduction in the length of hospital stay (p=0.00487; one-way ANOVA). Although patients were not followed up on discharge to assess re-admission rates, the results are relevant in order to inform the hospital staff about the implementation of antibiotic stewardship at the public hospital setting with the aims of reducing inappropriate antibiotic prescribing and improving patient outcomes. From the results of the study, it can be concluded that the hypothesis was achieved and that the clinical pharmacist did play an integral role in antibiotic prescribing at the public hospital setting. Thus, it can be concluded that the study, though limited in its scope, achieved its aims and objectives, and showed that the clinical pharmacist does play an integral role in the rational use of antibiotics in a public hospital setting.
- Full Text:
- Date Issued: 2015
Application of a quality by design approach to optimise an existing product
- Authors: Maxwell, Taryn Lee
- Date: 2018
- Subjects: Pharmaceutical chemistry , Drugs -- Design Pharmaceutical technology
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/32752 , vital:32341
- Description: Quality by design is a science and risk based approach whereby quality is built into the product or process during the pharmaceutical development. although quality by design is encouraged for pharmaceutical development. it is possible to apply quality by design to optimize an existing product as part of a continual improvement strategy. the purpose of this study is to determine which factors should be considered to justify the application of quality by design to optimize an existing product.
- Full Text: false
- Date Issued: 2018
- Authors: Maxwell, Taryn Lee
- Date: 2018
- Subjects: Pharmaceutical chemistry , Drugs -- Design Pharmaceutical technology
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/32752 , vital:32341
- Description: Quality by design is a science and risk based approach whereby quality is built into the product or process during the pharmaceutical development. although quality by design is encouraged for pharmaceutical development. it is possible to apply quality by design to optimize an existing product as part of a continual improvement strategy. the purpose of this study is to determine which factors should be considered to justify the application of quality by design to optimize an existing product.
- Full Text: false
- Date Issued: 2018
Audit of intravenous antifungal therapy used for Candida infections at a South African private hospital
- Authors: Van Dyk, Jacklyn Kate
- Date: 2020
- Subjects: Candidiasis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46380 , vital:39600
- Description: The epidemiological landscape of the candida species has changed with the emergence of MDR strains globally and in South Africa. The aim of this study was to critically evaluate the compliance to guidelines in the use of intravenous antifungal therapy when treating invasive Candidainfections in a South African private hospital.Objective One was to determine the prevalence of Candida auris(C.auris) in the sample. Objective Two examined the relationship between high-risk patients and positive microbiological cultures. Objective Three studied the prescribing utilisation of the intravenous antifungalsin the form of a clinical audit. Objective Four compared these prescribing patternsto current guidelines by evaluating whether the antifungal course was non-compliant, of suboptimal compliance or compliant. Objective Five was to design a protocol for ward pharmacists to use when assessing antifungal treatment for candidiasis. The research design consisted of a retrospective, non-experimental, cross-sectional analysis of intravenous antifungal use in the management of systemic Candida infections in a private sector hospital in the Gauteng province, South Africa.A positive research paradigm with a quantitative clinical audit was used in this study. The most prevalent species cultured was C.auris with 31 of the 77 positive cultures. Risk stratifying patients was validated with 70% of high risk patients (Candida Score >2.5 and positive β-D-glucan) having a corresponding positive culture. Echinocandins were the most frequently utilised antifungal class, with caspofungin being the most used antifungal in the sample. The average duration of therapy for the echinocandins ranged between 11 and 16 days. Compliance to guidelines was evaluated accordingto: reason for initiation; drug choice and drug dose. Three levels of compliance were determined: non-compliant, sub-optimal compliance and compliant. xivThe overall compliance,according to recommended treatment guidelines,was found to be suboptimal, with anidentified need foranintervention which targets thedosing of the antifungals used. In conclusion, the research findings highlight the importance of reviewing antifungal prescribing habits and the need for antifungal stewardship programmes.
- Full Text:
- Date Issued: 2020
- Authors: Van Dyk, Jacklyn Kate
- Date: 2020
- Subjects: Candidiasis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46380 , vital:39600
- Description: The epidemiological landscape of the candida species has changed with the emergence of MDR strains globally and in South Africa. The aim of this study was to critically evaluate the compliance to guidelines in the use of intravenous antifungal therapy when treating invasive Candidainfections in a South African private hospital.Objective One was to determine the prevalence of Candida auris(C.auris) in the sample. Objective Two examined the relationship between high-risk patients and positive microbiological cultures. Objective Three studied the prescribing utilisation of the intravenous antifungalsin the form of a clinical audit. Objective Four compared these prescribing patternsto current guidelines by evaluating whether the antifungal course was non-compliant, of suboptimal compliance or compliant. Objective Five was to design a protocol for ward pharmacists to use when assessing antifungal treatment for candidiasis. The research design consisted of a retrospective, non-experimental, cross-sectional analysis of intravenous antifungal use in the management of systemic Candida infections in a private sector hospital in the Gauteng province, South Africa.A positive research paradigm with a quantitative clinical audit was used in this study. The most prevalent species cultured was C.auris with 31 of the 77 positive cultures. Risk stratifying patients was validated with 70% of high risk patients (Candida Score >2.5 and positive β-D-glucan) having a corresponding positive culture. Echinocandins were the most frequently utilised antifungal class, with caspofungin being the most used antifungal in the sample. The average duration of therapy for the echinocandins ranged between 11 and 16 days. Compliance to guidelines was evaluated accordingto: reason for initiation; drug choice and drug dose. Three levels of compliance were determined: non-compliant, sub-optimal compliance and compliant. xivThe overall compliance,according to recommended treatment guidelines,was found to be suboptimal, with anidentified need foranintervention which targets thedosing of the antifungals used. In conclusion, the research findings highlight the importance of reviewing antifungal prescribing habits and the need for antifungal stewardship programmes.
- Full Text:
- Date Issued: 2020
Availability of pharmacoeconomic data and its use in the development of drug formularies in South Africa
- Authors: Keele, Mothobi Godfrey
- Date: 2008
- Subjects: Drugs -- Cost effectiveness , Pharmacy -- Economic aspects
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10146 , http://hdl.handle.net/10948/685 , Drugs -- Cost effectiveness , Pharmacy -- Economic aspects
- Description: In an attempt to manage scarce health care resources and keep drug expenditure low, health care administrators worldwide have to make careful considerations regarding the choice of drugs to be provided to patients within their systems. One of the key strategies that is being employed to achieve this goal is the use of formularies. A major challenge in the formulary development process is to use pharmacoeconomics and outcomes research effectively to arrive at formularies that simultaneously provide patients with effective pharmacotherapy whilst maintaining financial stability. The extent to which this can be successfully achieved depends to a large extent on the availability of appropriate pharmacoeconomic data. The primary objectives of this study were to describe the availability and quality of literature pertaining to South African based pharmacoeconomic research, and to establish the manner in and extent to which pharmacoeconomic data is used in drug formulary decision-making processes, in both the private and public health care sectors in South Africa. A structured bibliographic search for South African pharmacoeconomic studies was conducted and a qualitative assessment of the identified studies which met the predetermined inclusion criteria was completed, using a pre-validated quality evaluation tool. In order to determine the use of pharmacoeconomic data in the formulary decisionmaking processes, by various stake holders in both the public and private of health care sectors in South Africa, a cross-sectional, descriptive study using a self-administered questionnaire was conducted. The results suggest that there is a limited availability of pharmacoeconomic research data in South Africa. Only 16 full pharmacoeconomic studies could be identified as having been published between 01 January 1995 and 30 June 2007. The quality of 3 of these studies was considered to be ‘dubious’, one study was found to be of high standard whilst the other 12 (74.95%) were of acceptable quality and thus could be considered as suitable to be used in formulary decision-making. The results of the national survey indicated that pharmacoeconomics is considered to be of importance and is used in formulary decision-making processes in both the public and private sectors. The primary source of pharmacoeconomic data used in formulary decisions appears to be international peer-reviewed publications. Of concern however, is the finding that this data, mostly from studies conducted outside of South Africa, is applied directly without sensitivity analysis or modelling. The results of the literature search and the subsequent quality appraisal suggest that pharmacoeconomic research and the use of pharmacoeconomic data in formulary decisions is at its infancy in South Africa. Thus efforts are needed to develop and grow the discipline of pharmacoeconomics in South Africa.
- Full Text:
- Date Issued: 2008
- Authors: Keele, Mothobi Godfrey
- Date: 2008
- Subjects: Drugs -- Cost effectiveness , Pharmacy -- Economic aspects
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10146 , http://hdl.handle.net/10948/685 , Drugs -- Cost effectiveness , Pharmacy -- Economic aspects
- Description: In an attempt to manage scarce health care resources and keep drug expenditure low, health care administrators worldwide have to make careful considerations regarding the choice of drugs to be provided to patients within their systems. One of the key strategies that is being employed to achieve this goal is the use of formularies. A major challenge in the formulary development process is to use pharmacoeconomics and outcomes research effectively to arrive at formularies that simultaneously provide patients with effective pharmacotherapy whilst maintaining financial stability. The extent to which this can be successfully achieved depends to a large extent on the availability of appropriate pharmacoeconomic data. The primary objectives of this study were to describe the availability and quality of literature pertaining to South African based pharmacoeconomic research, and to establish the manner in and extent to which pharmacoeconomic data is used in drug formulary decision-making processes, in both the private and public health care sectors in South Africa. A structured bibliographic search for South African pharmacoeconomic studies was conducted and a qualitative assessment of the identified studies which met the predetermined inclusion criteria was completed, using a pre-validated quality evaluation tool. In order to determine the use of pharmacoeconomic data in the formulary decisionmaking processes, by various stake holders in both the public and private of health care sectors in South Africa, a cross-sectional, descriptive study using a self-administered questionnaire was conducted. The results suggest that there is a limited availability of pharmacoeconomic research data in South Africa. Only 16 full pharmacoeconomic studies could be identified as having been published between 01 January 1995 and 30 June 2007. The quality of 3 of these studies was considered to be ‘dubious’, one study was found to be of high standard whilst the other 12 (74.95%) were of acceptable quality and thus could be considered as suitable to be used in formulary decision-making. The results of the national survey indicated that pharmacoeconomics is considered to be of importance and is used in formulary decision-making processes in both the public and private sectors. The primary source of pharmacoeconomic data used in formulary decisions appears to be international peer-reviewed publications. Of concern however, is the finding that this data, mostly from studies conducted outside of South Africa, is applied directly without sensitivity analysis or modelling. The results of the literature search and the subsequent quality appraisal suggest that pharmacoeconomic research and the use of pharmacoeconomic data in formulary decisions is at its infancy in South Africa. Thus efforts are needed to develop and grow the discipline of pharmacoeconomics in South Africa.
- Full Text:
- Date Issued: 2008
Barriers to picking and packing in pharmaceutical warehousing and distribution in South Africa
- Authors: Kemp, Nicholas
- Date: 2018
- Subjects: Pharmaceutical industry -- Materials management , Warehouses -- Management Pharmaceutical industry -- South Africa Physical distribution of goods -- Management
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/30627 , vital:30994
- Description: Barriers within the supply chain play an evident role in decreasing its efficiency. The supply chain system is not well documented in the pharmaceutical sector. The aim of this study was to identify any barriers to the movement of picking and packing operators within 6 distribution facilities throughout South Africa using a time and motion analysis. A pilot study was initially conducted to choose the stopwatch application for Android® devices and to ensure reliability of the tools utilised. The motions during the processes of fulfilling an order were identified during the case picking, bulk picking and packing processes by direct observation of operators. The direct observation was performed using a stopwatch application for Android® devices and a tool on Microsoft Excel®. The data was analysed using Microsoft Excel®, using a student’s T-test and an analysis of variance (ANOVA) approach to identify similarities and differences between the facilities. The data was further analysed using a descriptive statistics approach to identify the common barriers amongst the distribution centres. Thereafter, the data was analysed by identifying a value-quotient. The value-quotient was used to identify how much time was spent on value-adding activities with each facility. The observation of the operators was done randomly at each facility to avoid subjectivity and bias. Results: The pilot study identified which stopwatch application was to be utilised. The pilot study aided to improve upon the design of the data collection tool used for the transcribing of the timing operation. The student’s T-test and ANOVA revealed that there were statistically significant differences in case picking amongst facilities, namely using the radio frequency identification devices (RFID), picking and transfer of stock. In the bulk picking process, there was a statistically significant difference amongst the facilities, namely using the RFID, pick and transfer of stock. In the packing process there was a statistically significant difference amongst the facilities in the packing process. The analysis of barriers within the distribution centres revealed that the 16 common barriers amongst the picking processes at the facilities included raising the platform, waiting for colleagues to depart an aisle, RFID malfunctions and answering their phones. No common barriers during the packing process was identified. The value-quotient revealed that most of the facilities spent more than 50 percent of their time on value-adding activities during the case picking, bulk picking and packing processes. A time and motion analysis proved to be an effective method to identify similarities and barriers between the six facilities. It was recommended to investigate a few of the basic operations to improve upon, as well as the possibility of implementing a barcoded system to the stock.
- Full Text:
- Date Issued: 2018
- Authors: Kemp, Nicholas
- Date: 2018
- Subjects: Pharmaceutical industry -- Materials management , Warehouses -- Management Pharmaceutical industry -- South Africa Physical distribution of goods -- Management
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/30627 , vital:30994
- Description: Barriers within the supply chain play an evident role in decreasing its efficiency. The supply chain system is not well documented in the pharmaceutical sector. The aim of this study was to identify any barriers to the movement of picking and packing operators within 6 distribution facilities throughout South Africa using a time and motion analysis. A pilot study was initially conducted to choose the stopwatch application for Android® devices and to ensure reliability of the tools utilised. The motions during the processes of fulfilling an order were identified during the case picking, bulk picking and packing processes by direct observation of operators. The direct observation was performed using a stopwatch application for Android® devices and a tool on Microsoft Excel®. The data was analysed using Microsoft Excel®, using a student’s T-test and an analysis of variance (ANOVA) approach to identify similarities and differences between the facilities. The data was further analysed using a descriptive statistics approach to identify the common barriers amongst the distribution centres. Thereafter, the data was analysed by identifying a value-quotient. The value-quotient was used to identify how much time was spent on value-adding activities with each facility. The observation of the operators was done randomly at each facility to avoid subjectivity and bias. Results: The pilot study identified which stopwatch application was to be utilised. The pilot study aided to improve upon the design of the data collection tool used for the transcribing of the timing operation. The student’s T-test and ANOVA revealed that there were statistically significant differences in case picking amongst facilities, namely using the radio frequency identification devices (RFID), picking and transfer of stock. In the bulk picking process, there was a statistically significant difference amongst the facilities, namely using the RFID, pick and transfer of stock. In the packing process there was a statistically significant difference amongst the facilities in the packing process. The analysis of barriers within the distribution centres revealed that the 16 common barriers amongst the picking processes at the facilities included raising the platform, waiting for colleagues to depart an aisle, RFID malfunctions and answering their phones. No common barriers during the packing process was identified. The value-quotient revealed that most of the facilities spent more than 50 percent of their time on value-adding activities during the case picking, bulk picking and packing processes. A time and motion analysis proved to be an effective method to identify similarities and barriers between the six facilities. It was recommended to investigate a few of the basic operations to improve upon, as well as the possibility of implementing a barcoded system to the stock.
- Full Text:
- Date Issued: 2018
Compliance with good distribution practice guidelines for cold chain products among pharmaceutical wholesalers in South Africa
- Authors: Masebe, Zandisile
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46390 , vital:39581
- Description: Background: The South African pharmaceutical cold chain distribution industry is highly regulated. Cold chain pharmaceutical products require storage in a cold room, in a temperature-controlled environment between (2°C-8°C) and the cold chain must be maintained at all times throughout the distribution process. The incorrect handling, storage, transport and distribution of cold chain products may reduce the potency and therapeutic effectiveness of the product which in turn may result in treatment failure. The research was aimed at determining the level of compliance to current Good Distribution Practice guidelines for cold chain products among pharmaceutical wholesalers and distributors in South Africa. Methodology: The study made use of quantitative research techniques. A purpose designed online questionnaire was used as a data collection tool from the study participants. The judgmental sampling technique was used in this study as it was found to be the most appropriate method for the research question. Phase one of the study was to conduct a pilot study at two Port Elizabeth pharmaceutical wholesalers. The data was analysed using Microsoft Excel®, chi-square test for goodness of fit and content analysis. The data was further analysed using a descriptive and inferential statistics approach to determine the level of compliance to regulatory guidelines for cold chain products.Results:The results obtained from the empirical study revealed that less than 50% of the study respondents indicated compliance to the factors listed in the regulatory guidelines for cold chain products distribution.These factors include cold chain monitoring, alternative power sources, validation of cold chain boxes and route transport validation.Conclusion:The wholesale pharmaceutical industry is experiencing challenges to comply with factors necessary to ensure compliance with GDP guidelines for cold chain products. Through the study it was proven that there is evidence of commitment by the industry to implement the GWP and GPP amendment guidelines, despite less than 50% of the respondents reporting compliance to the guidelines. Recommendations were provided to improve the level of compliance to guidelines for cold chain products by pharmaceutical wholesalers in South Africa.
- Full Text:
- Date Issued: 2020
- Authors: Masebe, Zandisile
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46390 , vital:39581
- Description: Background: The South African pharmaceutical cold chain distribution industry is highly regulated. Cold chain pharmaceutical products require storage in a cold room, in a temperature-controlled environment between (2°C-8°C) and the cold chain must be maintained at all times throughout the distribution process. The incorrect handling, storage, transport and distribution of cold chain products may reduce the potency and therapeutic effectiveness of the product which in turn may result in treatment failure. The research was aimed at determining the level of compliance to current Good Distribution Practice guidelines for cold chain products among pharmaceutical wholesalers and distributors in South Africa. Methodology: The study made use of quantitative research techniques. A purpose designed online questionnaire was used as a data collection tool from the study participants. The judgmental sampling technique was used in this study as it was found to be the most appropriate method for the research question. Phase one of the study was to conduct a pilot study at two Port Elizabeth pharmaceutical wholesalers. The data was analysed using Microsoft Excel®, chi-square test for goodness of fit and content analysis. The data was further analysed using a descriptive and inferential statistics approach to determine the level of compliance to regulatory guidelines for cold chain products.Results:The results obtained from the empirical study revealed that less than 50% of the study respondents indicated compliance to the factors listed in the regulatory guidelines for cold chain products distribution.These factors include cold chain monitoring, alternative power sources, validation of cold chain boxes and route transport validation.Conclusion:The wholesale pharmaceutical industry is experiencing challenges to comply with factors necessary to ensure compliance with GDP guidelines for cold chain products. Through the study it was proven that there is evidence of commitment by the industry to implement the GWP and GPP amendment guidelines, despite less than 50% of the respondents reporting compliance to the guidelines. Recommendations were provided to improve the level of compliance to guidelines for cold chain products by pharmaceutical wholesalers in South Africa.
- Full Text:
- Date Issued: 2020
Cost comparison between repackaging bulk oral solid medicines and purchasing manufacturer-prepared patient-ready packs in the public sector in South Africa
- Authors: Abahamye, Aloysius
- Date: 2014
- Subjects: Packaging -- Cost control , Business logistics -- Costs , Drugs -- Packaging , Manufacturing processes
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10163 , http://hdl.handle.net/10948/d1020596 , Drugs -- Packaging
- Description: In an attempt to have medicines available in patient-ready packs (PRPs) prior to the dispensing process, the provincial medicine depots in South Africa have, for many years, been repackaging bulk medicines into PRPs. Notwithstanding the fact that bulk medicine packages may have been the only packages available from the manufacturers to service the Primary Health Care (PHC) sector, the main aim of this process was to ensure that medicines were available in PRPs for dispensing to patients, thus, minimising the time spent on each prescription by the pharmacist, pharmacist’s assistant or Nurse. Currently, some medicines are being procured in PRPs from the manufacturers, whereas others are still procured in bulk packs which must be repackaged into PRPs. After a thorough literature search, it was established that, up until this point in time, no studies have been performed to compare costs of repackaged medicines from bulk packs with costs of medicines procured from manufacturers in PRPs. There was very scanty literature comparing the use of medicines procured either in PRPs or bulk packs. However, literature on cost comparison between repackaging and purchasing of commercially available manufacturer-prepared PRPs was not identified.
- Full Text:
- Date Issued: 2014
- Authors: Abahamye, Aloysius
- Date: 2014
- Subjects: Packaging -- Cost control , Business logistics -- Costs , Drugs -- Packaging , Manufacturing processes
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10163 , http://hdl.handle.net/10948/d1020596 , Drugs -- Packaging
- Description: In an attempt to have medicines available in patient-ready packs (PRPs) prior to the dispensing process, the provincial medicine depots in South Africa have, for many years, been repackaging bulk medicines into PRPs. Notwithstanding the fact that bulk medicine packages may have been the only packages available from the manufacturers to service the Primary Health Care (PHC) sector, the main aim of this process was to ensure that medicines were available in PRPs for dispensing to patients, thus, minimising the time spent on each prescription by the pharmacist, pharmacist’s assistant or Nurse. Currently, some medicines are being procured in PRPs from the manufacturers, whereas others are still procured in bulk packs which must be repackaged into PRPs. After a thorough literature search, it was established that, up until this point in time, no studies have been performed to compare costs of repackaged medicines from bulk packs with costs of medicines procured from manufacturers in PRPs. There was very scanty literature comparing the use of medicines procured either in PRPs or bulk packs. However, literature on cost comparison between repackaging and purchasing of commercially available manufacturer-prepared PRPs was not identified.
- Full Text:
- Date Issued: 2014
Delivery of pharmaceutical services and care at three primary healthcare clinics with different dispensing models in the Nelson Mandela Bay Health District
- Authors: Bobbins, Amy Claire
- Date: 2018
- Subjects: National health insurance -- South Africa , Community health services -- South Africa Pharmaceutical services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/23580 , vital:30583
- Description: As South Africa moves into an era of National Health Insurance (NHI), the idea of primary health care (PHC) re-engineering is placed at the forefront; however, the role of the pharmacist in this process remains vague. Task-shifting of the dispensing process to pharmacist’s assistants and nurses in PHC clinics is a common phenomenon, but the implications of this on the provision of pharmaceutical services and care to patients is largely unstudied. Thus, this study aims to explore these pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models present in PHC clinics. A two-phase, mixed methods approach was utilised, comprising of a pharmaceutical services audit and semi-structured interviews. The interviews provided insight into the lived experiences of personnel and patients of pharmaceutical care provision. Results revealed that although basic pharmaceutical services may be available at clinics with each of the three dispensing models, the quality is of a varying standard due to challenges in infrastructure and maintenance and poor personnel support. Furthermore, the provision of quality pharmaceutical care is minimal with all three dispensing models, resulting in a missed opportunity to optimise patient health outcomes in patient-centred PHC.
- Full Text:
- Date Issued: 2018
- Authors: Bobbins, Amy Claire
- Date: 2018
- Subjects: National health insurance -- South Africa , Community health services -- South Africa Pharmaceutical services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/23580 , vital:30583
- Description: As South Africa moves into an era of National Health Insurance (NHI), the idea of primary health care (PHC) re-engineering is placed at the forefront; however, the role of the pharmacist in this process remains vague. Task-shifting of the dispensing process to pharmacist’s assistants and nurses in PHC clinics is a common phenomenon, but the implications of this on the provision of pharmaceutical services and care to patients is largely unstudied. Thus, this study aims to explore these pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models present in PHC clinics. A two-phase, mixed methods approach was utilised, comprising of a pharmaceutical services audit and semi-structured interviews. The interviews provided insight into the lived experiences of personnel and patients of pharmaceutical care provision. Results revealed that although basic pharmaceutical services may be available at clinics with each of the three dispensing models, the quality is of a varying standard due to challenges in infrastructure and maintenance and poor personnel support. Furthermore, the provision of quality pharmaceutical care is minimal with all three dispensing models, resulting in a missed opportunity to optimise patient health outcomes in patient-centred PHC.
- Full Text:
- Date Issued: 2018
Development of a framework for a proposed antimicrobial usage reporting tool for public sector hospitals
- Authors: Ramjan, Yumna
- Date: 2019
- Subjects: Anti-infective agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/43030 , vital:36727
- Description: Background: The inappropriate and unnecessary use of antimicrobials has increased the need to monitor antimicrobial usage so as to identify inappropriate use. In order to support the antimicrobial stewardship (AMS) programme, it is important to quantify the usage of antimicrobials and this can be achieved by promoting the use of AMS utilisation metrics. They are used to measure the progress and efficacy of an AMS programme (Brotherton, 2018).Primary Aim of Research: The primary aim of the research was to develop a framework for a proposed antimicrobial usage reporting tool, which would integrate with various data sources in order to be used by AMS practitioners to optimise antimicrobial usage in the South African public sector hospital setting.Methodology: The study was divided into three phases: a preliminary phase, a developmental phase and a post-developmental phase. The preliminary phase focused on obtaining a comprehensive understanding of the type and nature of the AMS utilisation metrics and subsequently identifying the views on the usage, usefulness and clinical relevance of those AMS utilisation metrics using a quantitative questionnaire, which was conducted among infectious disease specialists, pharmacists, medical prescribers, i.e. prescribers who were not specialists and clinical pathologists employed at tertiary level, public sector hospitals in the Eastern Cape province of South Africa. Consequently, a qualitative semi-structured interview was conducted among healthcare professionals who were involved in the daily implementation of AMS in the workplace. Results obtained from the quantitative component and qualitative component were integrated in order to develop a framework for a proposed antimicrobial usage reporting tool. Results: The Defined Daily Dose (DDD), Prescribed Daily Dose (PDD) and Days of Therapy (DOT) were identified as the most common AMS metrics (Grau et al., 2013). However, the DDD was the only AMS metric currently recommended by the South African National Department of Health (South African National Department of Health, 2017a)and it was the only AMS metric currently being utilised at two of the five research sites in the Eastern Cape province of South Africa. It was identified that data pertaining to antimicrobial usage was available and was being extracted from Rx Solution®. However, the programme did not have the ability of automatically producing the reports, hence, emphasising on the need for an antimicrobial usage reporting tool for South African public sector hospitals. Therefore, the framework for the proposed antimicrobial usage reporting tool would integrate antimicrobial stock management data with the following AMS utilisation metrics: DDD, DOT and PDD, were considered for inclusion in the proposed antimicrobial usage reporting tool. Conclusion: The qualitative findings obtained during the post-developmental phase, therefore, established that although an electronic platform for the purpose of monitoring antimicrobial usage for the South African public sector hospitals was required, there would be many challenges obstructing the implementation of the proposed antimicrobial usage reporting tool.
- Full Text:
- Date Issued: 2019
- Authors: Ramjan, Yumna
- Date: 2019
- Subjects: Anti-infective agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/43030 , vital:36727
- Description: Background: The inappropriate and unnecessary use of antimicrobials has increased the need to monitor antimicrobial usage so as to identify inappropriate use. In order to support the antimicrobial stewardship (AMS) programme, it is important to quantify the usage of antimicrobials and this can be achieved by promoting the use of AMS utilisation metrics. They are used to measure the progress and efficacy of an AMS programme (Brotherton, 2018).Primary Aim of Research: The primary aim of the research was to develop a framework for a proposed antimicrobial usage reporting tool, which would integrate with various data sources in order to be used by AMS practitioners to optimise antimicrobial usage in the South African public sector hospital setting.Methodology: The study was divided into three phases: a preliminary phase, a developmental phase and a post-developmental phase. The preliminary phase focused on obtaining a comprehensive understanding of the type and nature of the AMS utilisation metrics and subsequently identifying the views on the usage, usefulness and clinical relevance of those AMS utilisation metrics using a quantitative questionnaire, which was conducted among infectious disease specialists, pharmacists, medical prescribers, i.e. prescribers who were not specialists and clinical pathologists employed at tertiary level, public sector hospitals in the Eastern Cape province of South Africa. Consequently, a qualitative semi-structured interview was conducted among healthcare professionals who were involved in the daily implementation of AMS in the workplace. Results obtained from the quantitative component and qualitative component were integrated in order to develop a framework for a proposed antimicrobial usage reporting tool. Results: The Defined Daily Dose (DDD), Prescribed Daily Dose (PDD) and Days of Therapy (DOT) were identified as the most common AMS metrics (Grau et al., 2013). However, the DDD was the only AMS metric currently recommended by the South African National Department of Health (South African National Department of Health, 2017a)and it was the only AMS metric currently being utilised at two of the five research sites in the Eastern Cape province of South Africa. It was identified that data pertaining to antimicrobial usage was available and was being extracted from Rx Solution®. However, the programme did not have the ability of automatically producing the reports, hence, emphasising on the need for an antimicrobial usage reporting tool for South African public sector hospitals. Therefore, the framework for the proposed antimicrobial usage reporting tool would integrate antimicrobial stock management data with the following AMS utilisation metrics: DDD, DOT and PDD, were considered for inclusion in the proposed antimicrobial usage reporting tool. Conclusion: The qualitative findings obtained during the post-developmental phase, therefore, established that although an electronic platform for the purpose of monitoring antimicrobial usage for the South African public sector hospitals was required, there would be many challenges obstructing the implementation of the proposed antimicrobial usage reporting tool.
- Full Text:
- Date Issued: 2019
Disclosure of HIV status and adherence to antiretroviral therapy
- Kubashe, Nomachina Theopatra
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
- Full Text:
- Date Issued: 2009
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
- Full Text:
- Date Issued: 2009
Evaluation of medicine safety reporting systems in South Africa
- Thornborrow-Geswind, Kirsten
- Authors: Thornborrow-Geswind, Kirsten
- Date: 2017
- Subjects: Drugs -- Side effects -- Research -- South Africa Pharmacoepidemiology -- Research -- South Africa , Medicine -- South Africa -- Safety measures Public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21439 , vital:29517
- Description: Pharmacovigilance is “the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem”. To date, no comprehensive study has been performed to evaluate the pharmacovigilance system in the public health sector in South Africa. The primary aim of this study was to evaluate the current status of pharmacovigilance systems within the public healthcare sector in South Africa, and the level of functioning of these systems, in order to provide relevant recommendations, where necessary, for improvement, using the Indicator-based Pharmacogivilance Assessment Tool (IPAT). National and provincial entities were deemed compulsory (n=14), while facilities were selected via random, stratified sampling to obtain a representation at each facility level (n=101). The IPAT was amended for relevance at each level of data collection. Indicators are classified as core and supplementary and compliance with core indicators shows the level of functioning National entities obtained an IPAT score of 36 out of a maximum of 72, achieving 50% compliance. Province D and Province G obtained overall IPAT scores of 29 and 12 respectively out of a maximum of 40, achieving an overall 72.5% and 30% compliance respectively Results at provincial and facility levels were not fully representative due to a limited response rate of 22.2% and 65.3% respectively. Regional/tertiary facilities and district facilities displayed increased awareness and implementation of pharmacovigilance activity than the lower levels of Community Health Centres (CHCs) and Primary Health Centres (PHCs). South Africa”s public healthcare system possesses the infrastructure for a well functioning pharmacovigilance system. However there are gaps in level of functioning at a national, provincial and facility level. Addressing these gaps would show a marked improvement in the system and go a long way towards the contribution of medicine safety information not only locally, but to aid other developing nations.
- Full Text:
- Date Issued: 2017
- Authors: Thornborrow-Geswind, Kirsten
- Date: 2017
- Subjects: Drugs -- Side effects -- Research -- South Africa Pharmacoepidemiology -- Research -- South Africa , Medicine -- South Africa -- Safety measures Public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21439 , vital:29517
- Description: Pharmacovigilance is “the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem”. To date, no comprehensive study has been performed to evaluate the pharmacovigilance system in the public health sector in South Africa. The primary aim of this study was to evaluate the current status of pharmacovigilance systems within the public healthcare sector in South Africa, and the level of functioning of these systems, in order to provide relevant recommendations, where necessary, for improvement, using the Indicator-based Pharmacogivilance Assessment Tool (IPAT). National and provincial entities were deemed compulsory (n=14), while facilities were selected via random, stratified sampling to obtain a representation at each facility level (n=101). The IPAT was amended for relevance at each level of data collection. Indicators are classified as core and supplementary and compliance with core indicators shows the level of functioning National entities obtained an IPAT score of 36 out of a maximum of 72, achieving 50% compliance. Province D and Province G obtained overall IPAT scores of 29 and 12 respectively out of a maximum of 40, achieving an overall 72.5% and 30% compliance respectively Results at provincial and facility levels were not fully representative due to a limited response rate of 22.2% and 65.3% respectively. Regional/tertiary facilities and district facilities displayed increased awareness and implementation of pharmacovigilance activity than the lower levels of Community Health Centres (CHCs) and Primary Health Centres (PHCs). South Africa”s public healthcare system possesses the infrastructure for a well functioning pharmacovigilance system. However there are gaps in level of functioning at a national, provincial and facility level. Addressing these gaps would show a marked improvement in the system and go a long way towards the contribution of medicine safety information not only locally, but to aid other developing nations.
- Full Text:
- Date Issued: 2017
Evaluation of product x pre and post cpv implementation
- Authors: Killian, Christopher Grant
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46447 , vital:39577
- Description: Purpose: Stage 3 of the pharmaceutical process validation lifecycle, is called continued process verification (CPV). CPV is the final stage of lifecycle management and is intended to provide ongoing assurance that during routine production that a process remains in a state of control. Since CPV is a relatively new focus area for regulators, many legacy products will not have undergone Stage 3 process validation. Therefore, an opportunity existed to review the impact and challenges of implementing CPV on a legacy product. Methodology: This study employed quantitative analysis to evaluate the impact of CPV on process stability and end product quality for Product X, a legacy product manufactured at a generics manufacturing facility. Initial Stage 3a CPV was used to review historical process data and identify special cause variation. Corrective and preventative actions were taken to address these statistical outliers and the impact of these process changes were evaluated in Stage 3b. Results: CPV implementation appeared to have an effect on process control, stability and capability for Product X. In Stage 3b, an increase in statistical outliers along with significant changes to process mean and standard deviation were seen for the critical process parameters, average mass and hardness. An improvement in process capability for the critical quality attributes, assay and dissolution, was also seen. Conclusion: The largest benefit of CPV implementation, especially for a legacy product, is the process knowledge gained. This provided opportunities for process improvement and ultimately benefited patient safety.
- Full Text:
- Date Issued: 2020
- Authors: Killian, Christopher Grant
- Date: 2020
- Subjects: Pharmaceutical industry
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/46447 , vital:39577
- Description: Purpose: Stage 3 of the pharmaceutical process validation lifecycle, is called continued process verification (CPV). CPV is the final stage of lifecycle management and is intended to provide ongoing assurance that during routine production that a process remains in a state of control. Since CPV is a relatively new focus area for regulators, many legacy products will not have undergone Stage 3 process validation. Therefore, an opportunity existed to review the impact and challenges of implementing CPV on a legacy product. Methodology: This study employed quantitative analysis to evaluate the impact of CPV on process stability and end product quality for Product X, a legacy product manufactured at a generics manufacturing facility. Initial Stage 3a CPV was used to review historical process data and identify special cause variation. Corrective and preventative actions were taken to address these statistical outliers and the impact of these process changes were evaluated in Stage 3b. Results: CPV implementation appeared to have an effect on process control, stability and capability for Product X. In Stage 3b, an increase in statistical outliers along with significant changes to process mean and standard deviation were seen for the critical process parameters, average mass and hardness. An improvement in process capability for the critical quality attributes, assay and dissolution, was also seen. Conclusion: The largest benefit of CPV implementation, especially for a legacy product, is the process knowledge gained. This provided opportunities for process improvement and ultimately benefited patient safety.
- Full Text:
- Date Issued: 2020
Factors relating to academic success in the first semester of the bachelor of pharmacy degree at NMMU
- Authors: Nagel, Timothy Shaun
- Date: 2017
- Subjects: Pharmacy -- Study and teaching , College students -- South Africa Academic achievement
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/14201 , vital:27446
- Description: Student throughput rates and academic achievement at universities are a concern at a national level in South Africa. Statistics have shown that on average, only ±17% of students who enrolled at a university, managed to graduate. The aim of the study was to determine the factors pertaining to student achievement and success in the first semester of the first year Bachelor of Pharmacy degree at the Nelson Mandela Metropolitan University. This study was a longitudinal, observational study which incorporated only quantitative aspects. Factors included in the investigation were: student motivation; learning styles; prior academic achievement; language use and sources of financial support. In order to determine student motivation, an Academic Motivation Scale (AMS) was used. Learning styles were assessed using a Kolb Learning Style Inventory (LSI) tool. The student’s National Senior Certificate (NSC) results were compared to the students 2016 semester one final marks, to correlate student readiness and prior academic achievement with current academic achievement. Home language and sources of financial support were also evaluated using a purpose-designed questionnaire. Results showed that only the Life Sciences module was practically and statistically significant as a predictor of academic success, with a p-value of .001 and a correlation coefficient |r| value of .369. The minimum entry requirements for the BPharm Degree do not include Life Science, however, based on this study, inclusion of Life Sciences at a specific achievement level should be considered.
- Full Text:
- Date Issued: 2017
- Authors: Nagel, Timothy Shaun
- Date: 2017
- Subjects: Pharmacy -- Study and teaching , College students -- South Africa Academic achievement
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/14201 , vital:27446
- Description: Student throughput rates and academic achievement at universities are a concern at a national level in South Africa. Statistics have shown that on average, only ±17% of students who enrolled at a university, managed to graduate. The aim of the study was to determine the factors pertaining to student achievement and success in the first semester of the first year Bachelor of Pharmacy degree at the Nelson Mandela Metropolitan University. This study was a longitudinal, observational study which incorporated only quantitative aspects. Factors included in the investigation were: student motivation; learning styles; prior academic achievement; language use and sources of financial support. In order to determine student motivation, an Academic Motivation Scale (AMS) was used. Learning styles were assessed using a Kolb Learning Style Inventory (LSI) tool. The student’s National Senior Certificate (NSC) results were compared to the students 2016 semester one final marks, to correlate student readiness and prior academic achievement with current academic achievement. Home language and sources of financial support were also evaluated using a purpose-designed questionnaire. Results showed that only the Life Sciences module was practically and statistically significant as a predictor of academic success, with a p-value of .001 and a correlation coefficient |r| value of .369. The minimum entry requirements for the BPharm Degree do not include Life Science, however, based on this study, inclusion of Life Sciences at a specific achievement level should be considered.
- Full Text:
- Date Issued: 2017
Future role of community pharmacy in the national health insurance
- Authors: Aluko, Olubusola Aderonke
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Community health services -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21472 , vital:29525
- Description: Governments all over the world have shown interest in the healthcare system and various policies and measures have been adopted to ensure optimum health of the people. Inequity in health provision in South Africa is a great challenge. In South Africa, the healthcare system is currently characterised by distinctly different public and private sectors. The public sector serves approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to, and quality of, health services. In particular, relative to the population it serves and the disease burden that it carries, the public sector is under-resourced. In order to address the inequities characteristic of the current two-tiered system, the South African Government is in the process of implementing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization within the public sector. Funding contributions will be linked to the ability of an individual to pay and benefits will be determined by an individual’s need for care. A core principle of NHI is to provide access to quality care. It has been suggested that within a NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies specifying the roles and functions of pharmacists in the NHI or in a re-engineered Primary Health Care system, although it has been suggested that for South Africa to have a successful healthcare system it requires the support and assistance of pharmacists. Research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study describes the perceptions and attitudes of community pharmacists and the lay public in Nelson Mandela Bay Metropole toward NHI and the potential role of community pharmacists within the NHI. A qualitative approach was used to provide an in-depth exploration of the attitudes and perceptions of community pharmacists and the lay public in Nelson Mandela Bay Metropole (NMBM). It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI. Semi-structured, in-depth interviews were conducted with both community pharmacists and with members of the public. The interviews were digitally recorded and then transcribed. The transcriptions were coded and analysed thematically. The analysis of the themes identified revealed that while community pharmacists and the public are aware of NHI they are uncertain as to how it is being implemented. However, both community pharmacists and patients see NHI as an advantage and display a positive attitude towards NHI.
- Full Text:
- Date Issued: 2018
- Authors: Aluko, Olubusola Aderonke
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Community health services -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21472 , vital:29525
- Description: Governments all over the world have shown interest in the healthcare system and various policies and measures have been adopted to ensure optimum health of the people. Inequity in health provision in South Africa is a great challenge. In South Africa, the healthcare system is currently characterised by distinctly different public and private sectors. The public sector serves approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to, and quality of, health services. In particular, relative to the population it serves and the disease burden that it carries, the public sector is under-resourced. In order to address the inequities characteristic of the current two-tiered system, the South African Government is in the process of implementing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization within the public sector. Funding contributions will be linked to the ability of an individual to pay and benefits will be determined by an individual’s need for care. A core principle of NHI is to provide access to quality care. It has been suggested that within a NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies specifying the roles and functions of pharmacists in the NHI or in a re-engineered Primary Health Care system, although it has been suggested that for South Africa to have a successful healthcare system it requires the support and assistance of pharmacists. Research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study describes the perceptions and attitudes of community pharmacists and the lay public in Nelson Mandela Bay Metropole toward NHI and the potential role of community pharmacists within the NHI. A qualitative approach was used to provide an in-depth exploration of the attitudes and perceptions of community pharmacists and the lay public in Nelson Mandela Bay Metropole (NMBM). It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI. Semi-structured, in-depth interviews were conducted with both community pharmacists and with members of the public. The interviews were digitally recorded and then transcribed. The transcriptions were coded and analysed thematically. The analysis of the themes identified revealed that while community pharmacists and the public are aware of NHI they are uncertain as to how it is being implemented. However, both community pharmacists and patients see NHI as an advantage and display a positive attitude towards NHI.
- Full Text:
- Date Issued: 2018
Identifying, recording and monitoring adverse effects associated with antriretroviral treatment
- Authors: Mulinge, Florence Muthoni
- Date: 2010
- Subjects: Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10131 , http://hdl.handle.net/10948/1491 , Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Description: South Africa, with an estimated 5.7 million people living with HIV, continues to have one of the largest epidemics in the world. The introduction of HAART resulted in prolonged and improved quality of life of many infected patients. However, adverse effects caused by these drugs have become a major concern as they affect the adherence of patients and in some cases even result in the death of patients. Although much research has been and is still being conducted in the area of understanding, preventing and management of ARV adverse effects, there is still a need for patients to be actively involved in self-monitoring for adverse effects. This will assist health care professionals in early identification of serious or potentially serious ARV effects. This study aimed at evaluating the usefulness of strategies developed and employed in the identification, recording and monitoring of adverse effects. The study was conducted with patients receiving HAART from a private HIV and AIDS clinic in Uitenhage, Eastern Cape, South Africa. The research project was approved by the Nelson Mandela Metropolitan University Research and Ethics Committee and the research site. This was an experimental, randomized controlled study carried out over a period of three months (August to October 2009), with a sample size of 160 patients divided into four study groups of 40 patients each. Two monitoring strategies, namely an ARV adverse effect monitoring tool and a patient self-monitoring diary were developed and used for the identification and recording of adverse effects. The four study groups included a Control group, a Tool group, a Diary group and a Tool-Diary group. Willing patients, after signing an informed consent form, were randomly assigned to one of the four groups by participating health care workers at the study site. Data was retrieved from the patient files by the researcher. Descriptive statistical analysis of the findings of the study was conducted using SPSS®. One hundred and forty nine patients were included in the final data analysis. Of the 80 diaries handed out to patients, only 33 were returned and due to errors only 31 were suitable for analysis. Monitoring tools were completed and analysed for 36 patients. The tool was found to be more effective in identifying adverse effects of a physical nature (such as peripheral neuropathy and lipodystrophy) than the usual methods of monitoring employed by the clinic, whilst the diary, used alone, was found to be less effective. Use of the tool and diary combined resulted in the most significant identification and recording of central nervous system related adverse effects and physical adverse effects. However due to the low return rate of the diaries and the majority of the monitoring tool not being completed in many instances the results of this study may not be generalisable. The study results did however suggest that combining the tool and the diary methods of adverse effect identification, yielded the most favourable results when compared to each method alone. This may be attributed to the fact that the tool is useful in identifying objective symptoms and the diaries subjective symptoms, particularly in instances where the patients forget to report their symptoms to healthcare professional whilst at the clinic. The diaries were also reported to improve adherence for more than 90 percentage (n=31) of the patients. More research would be needed in order to verify the exact significance of the tool and the diary in identifying and recording adverse effects and symptoms of adverse effects.
- Full Text:
- Date Issued: 2010
- Authors: Mulinge, Florence Muthoni
- Date: 2010
- Subjects: Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10131 , http://hdl.handle.net/10948/1491 , Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Description: South Africa, with an estimated 5.7 million people living with HIV, continues to have one of the largest epidemics in the world. The introduction of HAART resulted in prolonged and improved quality of life of many infected patients. However, adverse effects caused by these drugs have become a major concern as they affect the adherence of patients and in some cases even result in the death of patients. Although much research has been and is still being conducted in the area of understanding, preventing and management of ARV adverse effects, there is still a need for patients to be actively involved in self-monitoring for adverse effects. This will assist health care professionals in early identification of serious or potentially serious ARV effects. This study aimed at evaluating the usefulness of strategies developed and employed in the identification, recording and monitoring of adverse effects. The study was conducted with patients receiving HAART from a private HIV and AIDS clinic in Uitenhage, Eastern Cape, South Africa. The research project was approved by the Nelson Mandela Metropolitan University Research and Ethics Committee and the research site. This was an experimental, randomized controlled study carried out over a period of three months (August to October 2009), with a sample size of 160 patients divided into four study groups of 40 patients each. Two monitoring strategies, namely an ARV adverse effect monitoring tool and a patient self-monitoring diary were developed and used for the identification and recording of adverse effects. The four study groups included a Control group, a Tool group, a Diary group and a Tool-Diary group. Willing patients, after signing an informed consent form, were randomly assigned to one of the four groups by participating health care workers at the study site. Data was retrieved from the patient files by the researcher. Descriptive statistical analysis of the findings of the study was conducted using SPSS®. One hundred and forty nine patients were included in the final data analysis. Of the 80 diaries handed out to patients, only 33 were returned and due to errors only 31 were suitable for analysis. Monitoring tools were completed and analysed for 36 patients. The tool was found to be more effective in identifying adverse effects of a physical nature (such as peripheral neuropathy and lipodystrophy) than the usual methods of monitoring employed by the clinic, whilst the diary, used alone, was found to be less effective. Use of the tool and diary combined resulted in the most significant identification and recording of central nervous system related adverse effects and physical adverse effects. However due to the low return rate of the diaries and the majority of the monitoring tool not being completed in many instances the results of this study may not be generalisable. The study results did however suggest that combining the tool and the diary methods of adverse effect identification, yielded the most favourable results when compared to each method alone. This may be attributed to the fact that the tool is useful in identifying objective symptoms and the diaries subjective symptoms, particularly in instances where the patients forget to report their symptoms to healthcare professional whilst at the clinic. The diaries were also reported to improve adherence for more than 90 percentage (n=31) of the patients. More research would be needed in order to verify the exact significance of the tool and the diary in identifying and recording adverse effects and symptoms of adverse effects.
- Full Text:
- Date Issued: 2010
Impact of South African patient law on medicines and generic substitution
- Authors: Jaganath, Bhavrith
- Date: 2018
- Subjects: Drugs -- South Africa -- Generic substitution , Generic drugs -- South Africa Patent laws and legislation Patents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/22243 , vital:29907
- Description: Generic substitution of medicine is a mandatory cost- saving alternative made available to the public in South Africa . the availability of registered genetic medicine in the country is controlled by the South African Health products regulatory authority (SAHPRA), Formally known as the medicines control council (MCC), through the medicines and related substances act, No. 101 of 1965.
- Full Text:
- Date Issued: 2018
- Authors: Jaganath, Bhavrith
- Date: 2018
- Subjects: Drugs -- South Africa -- Generic substitution , Generic drugs -- South Africa Patent laws and legislation Patents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/22243 , vital:29907
- Description: Generic substitution of medicine is a mandatory cost- saving alternative made available to the public in South Africa . the availability of registered genetic medicine in the country is controlled by the South African Health products regulatory authority (SAHPRA), Formally known as the medicines control council (MCC), through the medicines and related substances act, No. 101 of 1965.
- Full Text:
- Date Issued: 2018
Implementation of a standardised insulin protocol in a tertiary level referral hospital
- Authors: Smith, Charné
- Date: 2012
- Subjects: Diabetics -- Treatment -- South Africa Insulin -- Patients -- South Africa , Drugs -- Dosage forms Diabetics -- Care -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/18387 , vital:28632
- Description: In severely ill hospitalised patients with diabetes mellitus (type 1 and type 2) there is an increase in metabolic rate. Insulin requirements are increased and glycaemic control becomes more difficult to achieve. The insulin sliding-scale is a form of „top up‟ therapy used to supplement the patients existing hypoglycaemic medication. In 2002, research at Livingstone Hospital found that 14 different sliding scales were used in 38 patients (Du Plessis, 2002: 79). In 2006 the nurses and doctors working in the general medical wards at Livingstone Hospital indicated that they were willing to use a standardised insulin sliding scale protocol (Smith, 2006: 56). Thus the aim of this study was to assess whether a standardised insulin protocol can be effectively implemented. The objectives of the study were to: 1) assess insulin usage via insulin sliding scales prior to the implementation of the standardised insulin protocol; 2) implement the standardised insulin protocol; and 3) reassess insulin usage after the implementation of the standardised insulin protocol. As the study involved evaluating the use of insulin via the insulin sliding scale and the implemented insulin protocol, it occurred in four phases. The preliminary phase entailed obtaining ethical approval. The pre-intervention phase included data collection in the form of a nursing questionnaire and the auditing of patient medical records using a data collection tool. The intervention phase involved education sessions on the new insulin protocol for the nursing staff, and the implementation of a standardised insulin protocol, while the post-intervention phase comprised of post-intervention data collection, which included a nursing questionnaire, a prescribers questionnaire and the auditing of patient medical records using a data collection tool. The overall impression obtained from the comparison between the pre- and post-intervention nursing questionnaire was conflicting; in some aspects the educational intervention was successful in others not. Regardless the indication obtained was that the nursing staff require more in-service training on a more regular basis as a lack of knowledge regarding diabetes mellitus as a disease state may negatively affect patient outcomes. The overall response from the nursing staff towards the insulin protocol was positive. The prescribers‟ response to the insulin protocol was conflicted. The number of correct insulin sliding scale doses administered in the pre-intervention and post intervention phase improved by 5.25 percent. The number of incorrect insulin sliding scale doses administered during the pre- and post -intervention phase decreased by 5.25 percent. These results are positive and may be due to fewer sliding scales being prescribed in the post-intervention phase and the implemented insulin protocol. Only three (5.55%; n=54) inpatients with Type 1 diabetes mellitus were placed on the implemented protocol that is, the basal bolus regime, and rarely were dose adjustments to their insulin made rendering the effectives of the protocol undesirable. Only four (7.40%; n=54) inpatients with Type 2 diabetes mellitus were placed on the implemented protocol that is, an intermediate- to long-acting insulin (Protophane®). However all four patients experienced immediate improvements in their fasting blood glucose levels. These results indicated that by adding an intermediate- to long-acting insulin (Protophane®) to the therapy of a patient with Type 2 diabetes mellitus fasting blood glucose levels decrease. This would improve patient outcomes and decrease the risk of related diabetic complications. These limited results may indicate a clinical inertia on the part of the prescribers. Unfortunately overall the educational intervention was not successful and the implementation of the protocol was not successful and did not yield the desired results.
- Full Text:
- Date Issued: 2012
- Authors: Smith, Charné
- Date: 2012
- Subjects: Diabetics -- Treatment -- South Africa Insulin -- Patients -- South Africa , Drugs -- Dosage forms Diabetics -- Care -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/18387 , vital:28632
- Description: In severely ill hospitalised patients with diabetes mellitus (type 1 and type 2) there is an increase in metabolic rate. Insulin requirements are increased and glycaemic control becomes more difficult to achieve. The insulin sliding-scale is a form of „top up‟ therapy used to supplement the patients existing hypoglycaemic medication. In 2002, research at Livingstone Hospital found that 14 different sliding scales were used in 38 patients (Du Plessis, 2002: 79). In 2006 the nurses and doctors working in the general medical wards at Livingstone Hospital indicated that they were willing to use a standardised insulin sliding scale protocol (Smith, 2006: 56). Thus the aim of this study was to assess whether a standardised insulin protocol can be effectively implemented. The objectives of the study were to: 1) assess insulin usage via insulin sliding scales prior to the implementation of the standardised insulin protocol; 2) implement the standardised insulin protocol; and 3) reassess insulin usage after the implementation of the standardised insulin protocol. As the study involved evaluating the use of insulin via the insulin sliding scale and the implemented insulin protocol, it occurred in four phases. The preliminary phase entailed obtaining ethical approval. The pre-intervention phase included data collection in the form of a nursing questionnaire and the auditing of patient medical records using a data collection tool. The intervention phase involved education sessions on the new insulin protocol for the nursing staff, and the implementation of a standardised insulin protocol, while the post-intervention phase comprised of post-intervention data collection, which included a nursing questionnaire, a prescribers questionnaire and the auditing of patient medical records using a data collection tool. The overall impression obtained from the comparison between the pre- and post-intervention nursing questionnaire was conflicting; in some aspects the educational intervention was successful in others not. Regardless the indication obtained was that the nursing staff require more in-service training on a more regular basis as a lack of knowledge regarding diabetes mellitus as a disease state may negatively affect patient outcomes. The overall response from the nursing staff towards the insulin protocol was positive. The prescribers‟ response to the insulin protocol was conflicted. The number of correct insulin sliding scale doses administered in the pre-intervention and post intervention phase improved by 5.25 percent. The number of incorrect insulin sliding scale doses administered during the pre- and post -intervention phase decreased by 5.25 percent. These results are positive and may be due to fewer sliding scales being prescribed in the post-intervention phase and the implemented insulin protocol. Only three (5.55%; n=54) inpatients with Type 1 diabetes mellitus were placed on the implemented protocol that is, the basal bolus regime, and rarely were dose adjustments to their insulin made rendering the effectives of the protocol undesirable. Only four (7.40%; n=54) inpatients with Type 2 diabetes mellitus were placed on the implemented protocol that is, an intermediate- to long-acting insulin (Protophane®). However all four patients experienced immediate improvements in their fasting blood glucose levels. These results indicated that by adding an intermediate- to long-acting insulin (Protophane®) to the therapy of a patient with Type 2 diabetes mellitus fasting blood glucose levels decrease. This would improve patient outcomes and decrease the risk of related diabetic complications. These limited results may indicate a clinical inertia on the part of the prescribers. Unfortunately overall the educational intervention was not successful and the implementation of the protocol was not successful and did not yield the desired results.
- Full Text:
- Date Issued: 2012
Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary level hospital
- Authors: Van Niekerk, Anida
- Date: 2010
- Subjects: Antibiotics -- Administration
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10160 , http://hdl.handle.net/10948/1325 , http://hdl.handle.net/10948/d1012901 , Antibiotics -- Administration
- Description: The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
- Full Text:
- Date Issued: 2010
- Authors: Van Niekerk, Anida
- Date: 2010
- Subjects: Antibiotics -- Administration
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10160 , http://hdl.handle.net/10948/1325 , http://hdl.handle.net/10948/d1012901 , Antibiotics -- Administration
- Description: The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
- Full Text:
- Date Issued: 2010