An evaluation of non-pharmacist led drug supply management in cape metropole primary health care clinics

Abstract

Purpose The shortage of pharmacists has resulted in the introduction of indirectly supervised professional nurses (PNs) and post basic pharmacist's assistants (PBPAs) managing drug supply in primary healthcare clinics (PHCCs). Anecdotal evidence suggests that these clinics have high levels of drug expiries and shortages. This study aimed at evaluating their drug supply management (DSM) system. It assessed the following amongst the cadres: (i) to assess their knowledge of ordering and inventory management, (ii) to describe their ordering and inventory management practices, (iii) to assess their storage practices against Good Pharmacy Practice standards, and (iv) to determine the predictors of their knowledge and practices, and finally (v) to determine their perceptions towards the supervisory support, the training they receive in drug supply management as well as identify their perceived needs;. Methodology The study was both quantitative and qualitative. The PHCCs (n=32) were selected from the Cape Town Metropole district. All the clinics with PBPAs (9) and 23 clinics with PNs managing pharmaceutical services were chosen. PN clinics were chosen using stratified random sampling from each subdistrict so as to get equal representation. A questionnaire was used to (i) quantitatively assess the DSM knowledge of ordering and stock-card evaluation principles of both cadres and (ii) ascertain the influence of predictors such as experience with DSM and the level of support offered by the supervising pharmacist (SP). The observational checklist determined adherence to GPP protocols e.g. stock-card maintenance and storage conditions. Qualitative data was also collected on training and support, challenges limiting effective DSM and recommendations on improving such limitations. The data was analysed usmg descriptive and inferential statistics, and thematic analysis for the qualitative data. Results The average score for the knowledge test was 54% with high scores in areas of knowledge of basic terms and emergency maintenance of stock levels. The non-pharmacist cadres performed poorly in the calculation section of the test scoring an average of 35%. For the DSM practices, 79% of the the first line anti-tuberculosis medicines had stock-cards. Thirty percent of these stock-cadres were updated on the day of the visit. Stock outs were generally not recorded as only 11 % of the stock-cards had this information recorded. The respondents cited limited time and insufficient personnel as causes of irregular record keeping and some felt their training should include a practical component. Regarding supervision, 94% of the respondents reported being in regular contact with their supervising pharmacist (SP). This support was largely done telephonically with only 31 % of the respondents reporting regular monthly visitations from their SP. The cadres's years of experience was found to be a major predictor for the knowledge (p=O.002, n=32, rs=O.531) and practices [(P=O.004, n=32, rs=O.500) for the availability of stock cards and (p=O.048, n=32, rs=O.353) for the correct filling in of the stock-cards] ofDSM using Spearman's rank correlation coefficient. Conclusion The knowledge test scores showed that both cadres do not understand the ordering and stock-card management principles. There is poor record keeping despite a high presence of stock-cards. There is a need for SPs to take an active role in administering practical training in DSM to improve the performance of nurses and PBPAs. The major predictor for DSM knowledge and practices is the number of years the cadre has spent managing DSM.