Dataset Information

Stretching the Boundaries: Tanzanian Pharmacy Workers' Views and Experiences of Providing STI Services for Men Who Have Sex with Men.

ABSTRACT:

Objective

To explore the views and experiences of providing assistance and treatment of sexually transmitted infections to same-sex practicing male clients among service providers at pharmacies and drugstores in Dar es Salaam, Tanzania. Previous research suggests that sexually transmitted infections are an increasing concern for this population. Due to stigma and discrimination, men who have sex with men face limited access to treatment, which might contribute to increased self-medication. However, limited research has been conducted on the role of the pharmaceutical service provider with regards to this population in sub-Saharan Africa.

Method

In January 2016, 16 service providers at private pharmacies and drugstores with previous experience of providing services to this population were purposively selected for open-ended face-to-face interviews. The analysis was guided by the grounded theory approach.

Results

The process that emerged was labelled "Stretching Boundaries for Pharmaceutical Responsibilities". This reflected informants' perceptions of themselves as being involved in a transition from having limited engagement in the care of same-sex practicing male clients to becoming regular service-providers to this group. Findings further revealed that the emotional commitment they developed for clients through this process led to a transgression of provider-client boundaries, which undermined objective decision-making when clients lacked prescription. Financial interests also emerged as an underlying motivation for providing incomplete or inaccurate drug dosages.

Conclusions

Further studies are required to better address incentives related to unregulated sale of drugs. Inter-professional networks between pharmacy and healthcare workers could support the development of targeted treatment for men who have sex with men and other key populations.

SUBMITTER: Larsson M

PROVIDER: S-EPMC5094583 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Stretching the Boundaries: Tanzanian Pharmacy Workers' Views and Experiences of Providing STI Services for Men Who Have Sex with Men.

Larsson Markus M Odberg Pettersson Karen K Kashiha John J Ross Michael W MW Agardh Anette A

PloS one 20161103 11

<h4>Objective</h4>To explore the views and experiences of providing assistance and treatment of sexually transmitted infections to same-sex practicing male clients among service providers at pharmacies and drugstores in Dar es Salaam, Tanzania. Previous research suggests that sexually transmitted infections are an increasing concern for this population. Due to stigma and discrimination, men who have sex with men face limited access to treatment, which might contribute to increased self-medicatio ...[more]

PMID: 27812206

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Project description:BackgroundPrevious research suggests that Tanzanian MSM might prefer consulting pharmacies and drugstores, rather than public healthcare services, when in need of STI medicines and treatment. Yet, few studies have explored the experiences of providing services to MSM clients among those working at pharmacies and drugstores and examined what challenges they encounter in providing these services.ObjectiveTo gain increased knowledge and understanding of the perceived challenges encountered by pharmacists and drugstore workers when providing STI services to MSM clients in Dar es Salaam, Tanzania.MethodIn early 2016, 16 semi-structured interviews were conducted with persons working at private pharmacies and drugstores in Dar es Salaam. Data were interpreted through qualitative content analysis.ResultsThe overarching theme that emerged was labelled 'Fighting an uphill battle', which reflected the challenges pharmacy workers experienced during interactions with MSM clients, and in particular service provision. Pharmacy workers tried to act upon the best of their knowledge to meet the needs of clients, given their understanding of risks and obstacles that MSM faced. Yet, the lack of educational and professional preparedness and insufficient financial and human resources, regarded as necessary to meet the needs of a stigmatised client group, formed barriers for effective service delivery.ConclusionsIn order to support pharmacists and drug-store workers in Tanzania to address perceived challenges for service delivery to MSM clients, systematic and continuous training on MSM's sexual health is required. Furthermore, inter-professional cooperation that harnesses provider involvement from all tiers in the healthcare system is essential to offer complementary services to ensure proper STI care and treatment. Thus, interventions that focus on inter-professional communication and interaction between pharmacists and physicians could have a positive impact on timely referrals of suspected STI cases among marginalised populations.

Project description:BACKGROUND:Patient medicines helpline services (PMHS) have been established at some National Health Service (NHS) Trusts in England, with the aim of providing medicines-related support to patients after they have been discharged. Addressing an important knowledge gap, this qualitative study sought to examine pharmacy professionals' experiences and perceptions of their PMHS, including perceived benefits of the services, and areas for improvement. METHODS:Invitations to participate were sent to all NHS Trusts within England that were known to provide a PMHS (n?=?117). Semi-structured interviews were conducted via telephone with 34 pharmacy professionals who provide a PMHS (female?=?76%, male?=?24%; predominantly from Acute NHS Trusts, 76%). Interviews were audio-recorded and transcribed verbatim. The RE-AIM framework for evaluating interventions (RE-AIM: Reach, Effectiveness, Adoption, Implementation, Maintenance) informed the development of the interview schedule and the analysis of the data using framework analysis. RESULTS:Two themes were generated from the analysis: Resources, and Perceived benefits. Findings illustrate how providing a PMHS with limited resources (e.g., no specific funding, understaffed) negatively impacts the implementation, maintenance and reach of PMHS, and the ability to evidence their effectiveness. Despite operating with limited resources, PMHS are considered to have many benefits for patients and healthcare organisations (e.g., providing a 'safety net' to patients during the transfer of care period, providing reassurance to patients, helping to optimise patients' medicines, resolving medicines-related errors, reducing the burden upon other services, and providing the potential to improve hospital services based upon the content of enquiries). However, actually establishing the effectiveness and cost-effectiveness of PMHS is challenging due to perceived logistical difficulties of collecting data, and the difficulty measuring hard outcomes (e.g., prevention of readmissions). CONCLUSIONS:PMHS are typically perceived to be under-resourced, although they are considered by pharmacy professionals to have several benefits for service users and NHS Trusts. For those sites that provide a PMHS, we recommend using enquiry data to improve hospital services, and to share ideas for implementing and maintaining a PMHS within a resource-limited context. High-quality research is needed to evidence the effectiveness and cost-effectiveness of PMHS, which may help to secure adequate resources for this service in the future.

Project description:BACKGROUND: Female Sex workers (FSW) are important in driving HIV transmission in West Africa. The Yerelon clinic in Burkina Faso has provided combined preventative and therapeutic services, including anti-retroviral therapy (ART), for FSWs since 1998, with evidence suggesting it has decreased HIV prevalence and incidence in this group. No data exists on the costs of such a combined prevention and treatment intervention for FSW. This study aims to determine the mean cost of service provision per patient year for FSWs attending the Yerelon clinic, and identifies differences in costs between patient groups. METHODS: Field-based retrospective cost analyses were undertaken using top-down and bottom-up costing approaches for 2010. Expenditure and service utilisation data was collated from primary sources. Patients were divided into groups according to full-time or occasional sex-work, HIV status and ART duration. Patient specific service use data was extracted. Costs were converted to 2012 US$. Sensitivity analyses considered removal of all research costs, different discount rates and use of different ART treatment regimens and follow-up schedules. RESULTS: Using the top-down costing approach, the mean annual cost of service provision for FSWs on or off ART was US$1098 and US$882, respectively. The cost for FSWs on ART reduced by 29%, to US$781, if all research-related costs were removed and national ART monitoring guidelines were followed. The bottom-up patient-level costing showed the cost of the service varied greatly across patient groups (US$505-US$1117), primarily due to large differences in the costs of different ART regimens. HIV-negative women had the lowest annual cost at US$505. CONCLUSION: Whilst FSWs may require specialised services to optimise their care and hence, the public health benefits, our study shows that the cost of ART provision within a combined prevention and treatment intervention setting is comparable to providing ART to other population groups in Africa.

Project description:Pharmacy practice has evolved to include direct patient care and interprofessional team models. Proper documentation of training and certification is required to verify eligibility for providing specialized services and for reimbursement. The objectives of this study were to assess pharmacists' views and perceptions on credentialing with respect to (1) familiarity and perceived importance of credentialing; (2) satisfaction with current credentialing tracking systems; and (3) challenges in adopting a centralized credentialing platform. This study used a cross-sectional, survey design to examine pharmacist perceptions of credentialing. The survey, distributed by the American Pharmacists Association from November 18, 2017 to December 2, 2017, consisted of 11 demographic items and 22 items about familiarity, importance, satisfaction and current systems of credentialing in pharmacy practice. Descriptive statistics were used to characterize the sample and outcome variables. Content analysis was conducted on freeform responses. Data were analyzed from 446 (7.3%) completed surveys of the 6,144 distributed. Respondents were primarily represented by pharmacists from chain stores (29.6%), outpatient clinics (16.6%), and academic settings (15.2%). Job titles included staff pharmacist (33.9%), clinical pharmacist (21.3%), and manager positions (18.3%). Nine of 10 pharmacists reported familiarity with credentialing and considered credentialing as important to the pharmacy profession. Majority agreed with the importance of having a centralized online platform to store credentialing information (96.1%) and to obtain reimbursement (97.1%). Poor integration of data among different platforms (16%) was a common reason for dissatisfaction with current tracking systems. Most respondents (96.5%) were willing to provide information necessary for credentialing; however, over half were concerned about security of the information. This study was among the first to examine pharmacist perceptions of credentialing. Pharmacists in this study were familiar with and responsive to participating in credentialing process. They were also supportive of having a centralized credentialing system, but held reservations about security of information.

Project description:IntroductionThe UK government advocates person-centred healthcare which is ideal for supporting patients to make appropriate lifestyle choices and to address non-adherence. The Community Pharmacy Future group, a collaboration between community pharmacy companies and independents in the UK, introduced a person-centred service for patients with multiple long-term conditions in 50 pharmacies in Northern England.ObjectiveDescribe the initial findings from the set up and delivery of a novel community pharmacy-based person-centred service.MethodPatients over fifty years of age prescribed more than one medicine including at least one for cardiovascular disease or diabetes were enrolled. Medication review and person-centred consultation resulted in agreed health goals and steps towards achieving them. Data were collated and analysed to determine appropriateness of patient recruitment process and quality of outcome data collection. A focus group of seven pharmacists was used to ascertain initial views on the service.ResultsWithin 3 months of service initiation, 683 patients had baseline clinical data recorded, of which 86.9% were overweight or obese, 53.7% had hypertension and 80.8% had high cardiovascular risk. 544 (77.2%) patients set at least one goal during the first consultation with 120 (22.1%) setting multiple goals. A majority of patients identified their goals as improvement in condition, activity or quality of life. Pharmacists could see the potential patient benefit and the extended role opportunities the service provided. Allowing patients to set their own goals occasionally identified gaps to be addressed in pharmacist knowledge.ConclusionPharmacists successfully recruited a large number of patients who were appropriate for such a service. Patients were willing to identify goals with the pharmacist, the majority of which, if met, may result in improvements in quality of life. While challenges in delivery were acknowledged, allowing patients to identify their own personalised goals was seen as a positive approach to providing patient services.

Dataset Information

Stretching the Boundaries: Tanzanian Pharmacy Workers' Views and Experiences of Providing STI Services for Men Who Have Sex with Men.

Objective

Method

Results

Conclusions

Publications

Stretching the Boundaries: Tanzanian Pharmacy Workers' Views and Experiences of Providing STI Services for Men Who Have Sex with Men.

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