Case management of malaria fever at community pharmacies in Pakistan: a threat to rational drug use / Manejo de casos de malaria en farmacias comunitarias de Pakistán: amenaza al uso racional de medicamentos

Objective: To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city). Method: A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy’s management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by different types of dispensers working at community pharmacies situated at different locations in the twin cities. Results: The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, in 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, no significant differences were observed in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities. Conclusion: The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel’s at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies (AU)

Objetivo: Documentar el manejo de casos de malaria no complicada en farmacias comunitarias situadas en las dos principales ciudades de Pakistán: Islamabad (la capital) y Rawalpindi (ciudad gemela). Método: Se diseñó un estudio comparativo transversal para documentar el manejo de la malaria no complicada en las farmacias comunitarias de las ciudades gemelas de Pakistán mediante visitas de pacientes simulados. Se realizaron visitas a 238 farmacias aleatoriamente seleccionadas para pedir consejo en un caso de un paciente simulado con malaria. El manejo de la farmacia se puntuó en un listado que incluía la recogida del historial y la provisión de asesoramiento e información. Se utilizaron los tests de Kruskal-Wallis y de Mann-Whitney U para comparar el manejo de los casos de malaria no complicada por los dispensadores trabajando en farmacias comunitarias gestionadas por diferentes proveedores y en diferentes localizaciones de las ciudades gemelas. Resultados: Los pacientes simulados fueron atendidos por vendedores (74,8%, n=178), farmacéuticos (5,4%, n= 13), y diplomados (19,8%, n=47). Se dispensó medicación en el 83,1% (n=198) de las visitas, pero pocos de los casos tratados estaban de acuerdo con las recomendaciones para el tratamiento de la malaria. Sin embargo, en el 14,8% de los casos (n=53) los pacientes simulados fueron remitidos directamente al médico. Hubo diferencia significativa en el proceso de recogida del historial entre los diferentes dispensadores (p.e. farmacéuticos, auxiliares de farmacia, diplomados en farmacia, y vendedores), mientras que no hubo diferencias significativas en la provisión de asesoramiento entre los diferentes dispensadores. Los farmacéuticos, si estaban disponibles en la farmacia, estaban más involucrados en el proceso de recogida del historial. Por otro lado, no se apreciaron diferencias significativas en el manejo del caso (recogida del historial y provisión de asesoramiento) para el tratamiento de la malaria entre las farmacias comunitarias de diferentes localizaciones de las ciudades gemelas (p.e. cerca de un hospital/supermercado/mercadillo). Conclusión: Los resultados del estudio revelaron que el proceso general de manejo de la malaria no complicada en farmacias comunitarias no estaba de acuerdo con las recomendaciones nacionales de tratamiento de malaria. Los pacientes fueron atendidos por personal de las farmacias sin entrenamiento en las farmacias sin ninguna idea de remisión al médico. Sin embargo, los farmacéuticos estaban más involucrados en la recogida del historial, aunque su disponibilidad en las farmacias comunitarias era baja (AU)

Nonprogramming relational database primer: a case study--pharmacist intervention audits.

Using a database product has never been easier. The above example may appear to be complicated, but the Alpha Four software program guides you at every step. You have to decide what you wish to accomplish, then set up the program to handle the task. Alpha Four (or any other nonprogrammable relational database) can also be used for formulary management, investigational drug accounting, personnel management, inventory, purchase order requisitions, etc. Some drug distribution systems provide access to the patient records and clinical information. If you learn how to operate a database manager, you can create reports that may not be available from the vendor. Computers have reduced the workload required for drug distribution. The future of pharmacy practice is headed toward a highly automated setting. New roles for the pharmacist may include the provision of information from the point of admission to discharge and possibly continued follow-up. This will all be an automated process with the pharmacist as a key resource person. If you do not learn how to control the computer systems you work with, they will eventually control you. You do not have to be an expert to learn how to use a database application. If computer applications are not already part of your professional responsibilities, they soon will be.

Globalization of the pharmaceutical industry: the physician's role in optimizing drug use.

In this new era of globalization, the physician must consider cultural differences in choosing methods of disseminating information so that practitioners in diverse settings may optimize drug usage. In addition, increasing competition, stimulated by the imminent unification of the European market in 1992, demands that the industry physician be concerned with developing possible new indications and cost-effective applications. These factors will enhance roles for the medical affairs physician in the pharmaceutical industry.