The Pharmacy services under the leadership of Mr Salomon (Sampie) van Staden, Senior Pharmacist for the Langeberg sub-district developed a program of central dispensing of burden of disease medicines.
This meant that patients, who visited the clinic monthly simply to collect pills, are now able to visit a community centre close to their homes and collect their drugs from there. To “qualify” for the alternative distribution point, patients need to be adherent and their health in a stable condition. The system works on an appointment system which enable the service to inform patients by means of verbal interaction and a pamphlet which points are open on specific dates. All medication is pre-packed and labeled at the central pharmacy according to the appointments made.
Upon arrival at the venue the patient’s observations, (Blood Pressure and Glucose Levels) are measured by one of the trained Community Based Carers affiliated to a NGO in the area. After which they are requested to queue for their medication. Although there is a pharmacist overseeing the process, the dispensing table is managed by the Post Basic Pharmacist Assistants and Post Basic pharmacist Learners students currently training in the area.
In this manner the trainees develop skills other than those that they would by working in a facility bound pharmacy. Once the patient has collected their medication and received their next appointment they may leave and go home. The average total time for a visit is under an hour from time of arrival to leaving with medication.
Should a patient’s observations be unsatisfactory, the patient is referred to the Nurse on duty, who refers him/her back to the clinic closest to them for further counseling, testing or a doctor’s visit.
Stable patients receiving medication for any of the following chronic diseases may collect medication from these sites: Hypertension, Diabetes, Epilepsy, Cardiovascular Illness, Mental Health, and Asthma (COPD). Other conditions that are suitable for this service are chronic skin diseases, various illnesses related to the Thyroid and general aging and Lupus.
The introduction of a burden of disease management register allows us to keep track of our clients and adherence counseling is intensified in cases of non-adherence. Unused medicine is handed to the pharmacy outreach team at the outreach sites and is then destroyed as per good pharmacy practice specifications.
One of the advantages that was quickly identified and is being used extensively is the opportunity to disseminate health education to a very specific target group. This has resulted in visits from other professionals such as the occupational therapists to discuss the effects of strokes and how to exercise affected parts, the dieticians often talk about ways to live and eat in a healthier way and of course the pharmacist always talks about adherence and compliance.
The intervention is currently unable to deliver ARV¡¦s and TB medication due to several factors that are in the process of being addressed and will hopefully be resolved by the end of 2012. These factors include:
- The legislation and policies around the dispensing of TB and HIV medication
- The stigma and attitudes attached to these illnesses.
- The issues around non-adherence in TB patients and how that will be addressed
- The complications and side-effects that arise from the ARVs and how these will be referred for immediate attention