Fever case management at private health facilities and private pharmacies on the Kenyan coast: analysis of data from two rounds of client exit interviews and mystery client visits.

BACKGROUND: Private sector availability and use of malaria rapid diagnostic tests (RDTs) lags behind the public sector in Kenya. Increasing channels through which quality malaria diagnostic services are available can improve access to testing and help meet the target of universal diagnostic testing. Registered pharmacies are currently not permitted to perform blood tests, and evidence of whether malaria RDTs can be used by non-laboratory private providers in line with the national malaria control guidelines is required to inform ongoing policy discussions in Kenya. METHODS: Two rounds of descriptive cross-sectional exit interviews and mystery client surveys were conducted at private health facilities and registered pharmacies in 2014 and 2015, 6 and 18 months into a multi-country project to prime the private sector market for the introduction of RDTs. Data were collected on reported RDT use, medicines received and prescribed, and case management of malaria test-negative mystery clients. Analysis compared outcomes at facilities and pharmacies independently for the two survey rounds. RESULTS: Across two rounds, 534 and 633 clients (including patients) from 130 and 120 outlets were interviewed, and 214 and 250 mystery client visits were completed. Reported testing by any malaria diagnostic test was higher in private health facilities than registered pharmacies in both rounds (2014: 85.6% vs. 60.8%, p < 0.001; 2015: 85.3% vs. 56.3%, p < 0.001). In registered pharmacies, testing by RDT was 52.1% in 2014 and 56.3% in 2015. At least 75% of test-positive patients received artemisinin-based combination therapy (ACT) in both rounds, with no significant difference between outlet types in either round. Provision of any anti-malarial for test-negative patients ranged from 0 to 13.9% across outlet types and rounds. In 2015, mystery clients received the correct (negative) diagnosis and did not receive an anti-malarial in 75.5% of visits to private health facilities and in 78.4% of visits to registered pharmacies. CONCLUSIONS: Non-laboratory staff working in registered pharmacies in Kenya can follow national guidelines for diagnosis with RDTs when provided with the same level of training and supervision as private health facility staff. Performance and compliance to treatment recommendations are comparable to diagnostic testing outcomes recorded in private health facilities.

Unmasking the Unrecognized: Exploring Registered Pharmacy Technicians' Stressors During COVID-19 Through a Demands-Resources Inquiry and Looking Ahead.

Canadian registered pharmacy technicians (RPTs) were vital in supporting pharmacy operations during the pandemic. However, they have received little attention during or pre-pandemic. This study aimed to identify and understand the stressors experienced by Canadian RPTs during the pandemic and gain insights on lessons learned to help improve the profession. Through a descriptive qualitative design, virtual semi-structured focus groups were conducted with RPTs who were recruited through various sampling methods across Canada. Data were inductively analyzed and then deductively; themes were categorized using the Job Demands-Resources (JD-R) model. We reached data saturation after 4 focus group sessions with a total of 16 participants. As per the JD-R model, job demands included: (1) increased work volume and hours to meet patient demand; (2) drug shortages and managing prescriptions increased due to influx of orders coinciding with restricted access to medications; (3) fear of the unknown nature of COVID-19 met with frequent change in practices due to protocol changes and ineffective communication; and, (4) the pandemic introduced several factors leading to increased staff shortages. Themes pertaining to resources included: (1) poor incentives and limited access to well-being resources; (2) limited personal protective equipment delaying work operations; (3) and a general lack of knowledge or appreciation of the profession impacting work morale. Lessons learned from the pandemic were also provided. Overall, our findings revealed an imbalance where RPTs experienced high job demands with limited resources. Improved leadership within pharmacies, including improved communication between team members, is required. Furthermore, efforts to highlight and recognize the work of RPTs to the public is important to help improve enrollment, especially with their recent scope of practice expansion.