Implementation and Operational Research: A Comparison of Two Task-Shifting Models of Pharmaceutical Care in Antiretroviral Treatment Programs in South Africa.
J Acquir Immune Defic Syndr
; 71(4): e107-13, 2016 Apr 01.
Article
en En
| MEDLINE
| ID: mdl-26627104
ABSTRACT
BACKGROUND:
The severe shortage of pharmacists is an important limitation to providing antiretroviral treatment (ART) in resource-limited countries. Two task-shifting pharmaceutical care models have been developed to address this in South Africa, namely indirectly supervised pharmacist assistant (ISPA) and nurse-managed models. This study compared pharmaceutical care quality, patient clinical outcomes, and provider staff costs between these models.METHODS:
An analysis of pharmaceutical quality audits, patient clinical data, and staff costing data collected at 7 ISPA and 8 nurse-managed facilities was undertaken. Pharmaceutical audits were conducted by pharmacists using a standardized tool. Routine clinical data were collected prospectively at patient visits, and staff human resources costs were analyzed.RESULTS:
Overall pharmaceutical care quality scores were higher at ISPA sites than nurse-managed sites; 88.8% vs. 79.9%, respectively; risk ratio (ISPA vs. nurse) = 1.11 (95% confidence interval 1.09 to 1.13; P < 0.0001). Mean provider pharmaceutical-related human resources costs per patient visit and per item dispensed were 29% and 49% lower, respectively, at ISPA facilities. At ISPA facilities, patient attrition was observed to be lower and viral suppression higher than at nurse-managed sites.CONCLUSION:
The ISPA model had a higher quality of pharmaceutical care and was less costly to implement. Further expansion of this model or integrating it with nurse-managed ART may enhance the cost-efficient scale-up of ART programs in Sub-Saharan Africa.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Farmacéuticos
/
Infecciones por VIH
/
Fármacos Anti-VIH
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Atención a la Salud
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Delegación Profesional
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Enfermeras y Enfermeros
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Sysrev_observational_studies
Límite:
Humans
País como asunto:
Africa
Idioma:
En
Año:
2016
Tipo del documento:
Article