Pharmaceutical care integration in rural public health districts

Abstract

Background: South Africa’s healthcare system is in transition, which presents an opportunity for public sector pharmaceutical service development. Focus on primary healthcare (PHC) re-engineering and the National Health Insurance (NHI) mandate reinforce the importance of many healthcare professionals and processes, thus highlighting the need to explore the pivotal role pharmacists can play in a collaborative approach to primary healthcare. Setting: This study was conducted in uMzinyathi and Ugu, two rural districts in KwaZulu-Natal, South Africa. Methods: A mixed method research methodology was adopted in four phases. Key informants as well as PHC authorised prescribers, visiting doctors and pharmacists who support the “ideal” clinics participated in the study. Data were collected through specifically designed questionnaires and focus group interviews. The PHC facilities were also inspected for legal compliance using the South African Pharmacy Council’s primary health care clinics inspection questionnaire. Data were interpreted thematically and using factor analysis. Results: This study found that pharmacists can improve primary care at public clinics. Public health, primary care and clinical patient outcomes were also highlighted. Continuing nursing and pharmacy education, patient safety and quality of care were also significant collaborative intervention criteria. This study demonstrated statistically significant differences between doctors and authorised nurse prescribers in four medication processes: diagnosis and prescribing; administration and documentation; education and training; and medication review. Pharmacists focussed more on pharmaceutical care – monitoring patient compliance, educating patients about chronic medication, providing drug information to prescribers, and identifying prescribing errors rather than prescribing rights. Conclusion: The role of pharmacists in rural public healthcare was unexploited. Therefore, to ensure optimal patient outcomes and safety, pharmacist advocacy in these underserved rural communities could drive pharmacovigilance through adverse drug reporting, antibiotic stewardship, medicine supply management, clinical governance with ongoing prescription audits, structured training for PHC authorised nurse prescribers, patient engagement, and interaction. This study identifies barriers such as unclear roles, lack of transportation for outreach services, language difficulties, a lack of resources and devices, and a lack of doctors as well as authorised nurse prescribers. As the NHI is expanded, the pharmacist’s role and collaboration with doctors and authorised nurse prescribers could improve patient health outcomes and rural public healthcare delivery