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Economic evaluation of task-shifting approaches to the dispensing of anti-retroviral therapy.

Foster N, McIntyre D - Hum Resour Health (2012)

Bottom Line: The ISPA model was found to be the least costly task-shifting pharmaceutical model.However, patients preferred receiving medication from the nurse.While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa. Nicola.Foster@uct.ac.za.

ABSTRACT

Background: A scarcity of human resources for health has been identified as one of the primary constraints to the scale-up of the provision of Anti-Retroviral Treatment (ART). In South Africa there is a particularly severe lack of pharmacists. The study aims to compare two task-shifting approaches to the dispensing of ART: Indirectly Supervised Pharmacist's Assistants (ISPA) and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART.

Methods: A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted.

Results: The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy.

Conclusions: While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

No MeSH data available.


Respondent travel- and waiting-time.
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Figure 1: Respondent travel- and waiting-time.

Mentions: The ISPA facilities had similar absolute staff FTEs (1.2 versus 1.8) and ratios of patients on ART to FTE at 378:1 and 345:1, respectively. Thus, patient load does not explain the high average waiting time at ISPA clinic 1 of four hours and seventeen minutes (see Figure‚ÄČ1). This facility was struggling under the lack of a fulltime ART physician, which slowed down the renewal of prescriptions and ultimately the dispensing process. ISPA clinic 2 also had significant assistance in the dispensing process by the nurse; this included the ordering of medication for patients, and ensuring that the prescription is in order for patients only coming for repeat medication.


Economic evaluation of task-shifting approaches to the dispensing of anti-retroviral therapy.

Foster N, McIntyre D - Hum Resour Health (2012)

Respondent travel- and waiting-time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473241&req=5

Figure 1: Respondent travel- and waiting-time.
Mentions: The ISPA facilities had similar absolute staff FTEs (1.2 versus 1.8) and ratios of patients on ART to FTE at 378:1 and 345:1, respectively. Thus, patient load does not explain the high average waiting time at ISPA clinic 1 of four hours and seventeen minutes (see Figure‚ÄČ1). This facility was struggling under the lack of a fulltime ART physician, which slowed down the renewal of prescriptions and ultimately the dispensing process. ISPA clinic 2 also had significant assistance in the dispensing process by the nurse; this included the ordering of medication for patients, and ensuring that the prescription is in order for patients only coming for repeat medication.

Bottom Line: The ISPA model was found to be the least costly task-shifting pharmaceutical model.However, patients preferred receiving medication from the nurse.While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa. Nicola.Foster@uct.ac.za.

ABSTRACT

Background: A scarcity of human resources for health has been identified as one of the primary constraints to the scale-up of the provision of Anti-Retroviral Treatment (ART). In South Africa there is a particularly severe lack of pharmacists. The study aims to compare two task-shifting approaches to the dispensing of ART: Indirectly Supervised Pharmacist's Assistants (ISPA) and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART.

Methods: A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted.

Results: The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy.

Conclusions: While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

No MeSH data available.