Different models of pharmaceutical services and care in primary healthcare clinics in the Eastern Cape, South Africa: Challenges and opportunities for pharmacy practice.

BACKGROUND: Primary health care (PHC) re-engineering forms a crucial part of South Africa's National Health Insurance (NHI), with pharmaceutical services and care being crucial to treatment outcomes. However, owing to a shortage of pharmacists within PHC clinics, task-shifting of the dispensing process to pharmacist's assistants and nurses is common practice. The implications of this task-shifting process on the provision of pharmaceutical services and care remains largely unstudied. AIM: The study aimed to explore the pharmacist-based, pharmacist's assistant-based and nurse-based dispensing models within the PHC setting. SETTING: The Nelson Mandela Bay Health District, South Africa. METHODS: A mixed methods approach was utilised comprising of Phase 1: a pharmaceutical services audit to analyse pharmaceutical service provision and Phase 2: semi-structured interviews to describe the pharmaceutical care provision within each dispensing model thematically. RESULTS: Pharmaceutical services partially fulfilled minimum standards within all models, however, challenges exist that limit the quality of these services. Phase 2 showed that the provision of pharmaceutical care within all models was restricted by context-related constraints, thus patient-centred activities to underpin pharmaceutical services were limited. CONCLUSION: Although pharmaceutical services may have been available for all models, compromised quality of these services impacted overall quality of care. Limited pharmaceutical care provision was evident within each dispensing model. The results raised concerns about the current utilisation of pharmacy personnel, including the pharmacist, within the PHC setting. Further opportunities exist, if constraints allow, for the pharmacist to contribute to better patient-centred care.

Causes, consequences, and policy responses to the migration of health workers: key findings from India.

BACKGROUND: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been "sources" of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. METHODS: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. RESULTS: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. CONCLUSIONS: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

The need for PGY2-trained clinical pharmacy specialists.

The American College of Clinical Pharmacy and other stakeholder organizations seek to advance clinical pharmacist practitioners, educators, and researchers. Unfortunately, there remains an inadequate supply of residency-trained clinical specialists to meet the needs of our health care system, and nonspecialists often are called on to fill open specialist positions. The impact of clinical pharmacy specialists on pharmacotherapy outcomes in both acute care and primary care settings demonstrates the value of these specialists. This commentary articulates the need for postgraduate year two (PGY2)-trained clinical specialists within the health care system by discussing various clinical and policy rationales, interprofessional support, economic justifications, and their impact on quality of care and drug safety. The integrated practice model that has grown out of the American Society of Health-System Pharmacists Pharmacy Practice Model Initiative (PPMI) could threaten the growth and development of future clinical specialists. Therefore, the ways in which PGY2-trained clinical pharmacist specialists are deployed in the PPMI require further consideration. PGY2 residencies provide education and training opportunities that cannot be achieved in traditional professional degree programs or postgraduate year one residencies. These specialists are needed to provide direct patient care to complex patient populations and to educate and train pharmacy students and postgraduate residents. Limitations to training and hiring PGY2-trained clinical pharmacy specialists include site capacity limitations and lack of funding. A gap analysis is needed to define the extent of the mismatch between the demand for specialists by health care systems and educational institutions versus the capacity to train clinical pharmacists at the specialty level.

El farmacéutico y el equipo de salud: un nuevo paradigma de relaciones interprofesionales / The pharmacists and the health care team: a new paradigm of interprofesional relations

La labor de los distintos agentes sanitarios está dirigida al bien del paciente, principalmente a la prevención de enfermedades y la curación de enfermos. No obstante, las relaciones entre los profesionales de la salud no siempre han estado bien definidas. Ello ha dado lugar a discrepancias entre ellos, con el consiguiente perjuicio para los pacientes. Precisamente, en la actualidad, uno de los retos fundamentales en el ámbito sanitario es conseguir una verdadera integración de todos los agentes que tienen a su cargo el cuidado de la salud, los cuales constituyen auténticos equipos, en los que cada profesional pueda aportar, de manera coordinada, sus conocimientos y habilidades. Ésta es la propuesta que se presenta en el texto, la cual remite, en definitiva, a la necesidad de plantear un cambio en el actual paradigma de las relaciones entre los miembros del equipo sanitario (AU)

The work of different health care assistants is directed towards the well being of the patient, mainly the prevention and cure of diseases. Nevertheless, the relations among the different healthcare professionals have not always been well defined. This has caused disagreements among them, with the result of prejudgment for the patients. At present, precisely one of the fundamental challenges of the health care field is to achieve a real integration of all the assistants who are in charge of health care, forming real teams wherein every professional can contribute in a coordinated manner their knowledge and skills. This is the proposal presented in this text, that is, the need for a change in the present paradigm of the relations among the different members of the healthcare team (AU)

Formulacion e implantacion de politicas farmaceuticas: El caso de Chile / Pharmaceutical policies formulation and settlement: Chile's case

Se describe la politica farmaceutica vigente en Chile que acoge a la industria farmaceutica sin muchos obstaculos de importacion, fabricacion, precios y patentes. Se elaboran formas farmaceuticas a partir de principios activos de paises extranjeros que mueven aproximadamente 150 millones de dolares como inversion. la competencia generada y la libre comercializacion, respaldada por las politicas farmaceuticas pretende hacer mas accesible el medicamento. Se cuenta con un formulario nacional de medicamentos genericos y una lista de alternativas farmaceuticas de monodrogas comercializadas en el pais con un total de 653 principios activos y 2300 especialidades farmaceuticas. El consumo de medicamentos sigue el perfil de morbilidad nacional prevaleciendo el consumo de antibioticos, psicofarmacos, analgesicos y antiinflamatorios. Los precios son fijados libremente por los laboratorios, incrementados en un 20 por ciento por los mayoristas y un 25 a 35 por ciento por las farmacias. Se cuentan con medio para el uso racional de medicamentos