Time to revisit the skills and competencies required to work in rural general hospitals.

OBJECTIVES: To determine the structure and demographic of medical teams working in Rural General Hospitals (RGHs) in Scotland, and to gain insight into their experiences and determine their opinions on a remote and rural medical training pathway. DESIGN: Structured face-to-face interviews. Interviews were partially anonymised, and underwent thematic analysis. SETTING: Medical departments of the six RGHs in Scotland 2018-2019. PARTICIPANTS: 14 medical consultants and 23 junior doctors working in RGHs in Scotland. Inclusion criteria: Present at time of site visit, medical consultant in an RGH or junior doctor working in an RGH who provides care for medical patients. Exclusion criteria: Doctors on leave or off shift. Medical consultants with less than one month of experience in post. Non-medical specialty consultants e.g. surgical or anaesthetic consultants. RESULTS: Of 21 consultant posts in the RGHs, only eight are filled with resident consultants, the remainder rely on locums. Consultants found working as generalists rewarding and challenging, and juniors found it to be a good training experience. Consultants feel little professional isolation due to modern connectivity. The majority of consultants (12/14) and all junior doctors favour a remote and rural medicine training pathway encompassing a mandatory paediatrics component, and feel this would help with consultant recruitment and retention. CONCLUSION: RGHs medical departments are reliant on locum consultants. The development of a remote and rural training medical training pathway is endorsed by the current medical teams of RGHs and has the potential to improve medical consultant staffing in RGHs.

Public health interventions to protect against falsified medicines: a systematic review of international, national and local policies.

BACKGROUND: Falsified medicines are deliberately fraudulent drugs that pose a direct risk to patient health and undermine healthcare systems, causing global morbidity and mortality. OBJECTIVE: To produce an overview of anti-falsifying public health interventions deployed at international, national and local scales in low and middle income countries (LMIC). DATA SOURCES: We conducted a systematic search of the PubMed, Web of Science, Embase and Cochrane Central Register of Controlled Trials databases for healthcare or pharmaceutical policies relevant to reducing the burden of falsified medicines in LMIC. RESULTS: Our initial search identified 660 unique studies, of which 203 met title/abstract inclusion criteria and were categorised according to their primary focus: international; national; local pharmacy; internet pharmacy; drug analysis tools. Eighty-four were included in the qualitative synthesis, along with 108 articles and website links retrieved through secondary searches. DISCUSSION: On the international stage, we discuss the need for accessible pharmacovigilance (PV) global reporting systems, international leadership and funding incorporating multiple stakeholders (healthcare, pharmaceutical, law enforcement) and multilateral trade agreements that emphasise public health. On the national level, we explore the importance of establishing adequate medicine regulatory authorities and PV capacity, with drug screening along the supply chain. This requires interdepartmental coordination, drug certification and criminal justice legislation and enforcement that recognise the severity of medicine falsification. Local healthcare professionals can receive training on medicine quality assessments, drug registration and pharmacological testing equipment. Finally, we discuss novel technologies for drug analysis which allow rapid identification of fake medicines in low-resource settings. Innovative point-of-purchase systems like mobile phone verification allow consumers to check the authenticity of their medicines. CONCLUSIONS: Combining anti-falsifying strategies targeting different levels of the pharmaceutical supply chain provides multiple barriers of protection from falsified medicines. This requires the political will to drive policy implementation; otherwise, people around the world remain at risk.