A model for a drug distribution system in remote Australia as a social determinant of health using event structure analysis

John P Rovers,Michelle D Mages

doi:10.1186/s12913-017-2629-x

Abstract

BackgroundThe social determinants of health include the health systems under which people live and utilize health services. One social determinant, for which pharmacists are responsible, is designing drug distribution systems that ensure patients have safe and convenient access to medications. This is critical for settings with poor access to health care. Rural and remote Australia is one example of a setting where the pharmacy profession, schools of pharmacy, and regulatory agencies require pharmacists to assure medication access. Studies of drug distribution systems in such settings are uncommon. This study describes a model for a drug distribution system in an Aboriginal Health Service in remote Australia. The results may be useful for policy setting, pharmacy system design, health professions education, benchmarking, or quality assurance efforts for health system managers in similarly remote locations. The results also suggest that pharmacists can promote access to medications as a social determinant of health.The primary objective of this study was to propose a model for a drug procurement, storage, and distribution system in a remote region of Australia. The secondary objective was to learn the opinions and experiences of healthcare workers under the model.MethodsQualitative research methods were used. Semi-structured interviews were performed with a convenience sample of 11 individuals employed by an Aboriginal health service. Transcripts were analyzed using Event Structure Analysis (ESA) to develop the model. Transcripts were also analyzed to determine the opinions and experiences of health care workers.ResultsThe model was comprised of 24 unique steps with seven distinct components: choosing a supplier; creating a list of preferred medications; budgeting and ordering; supply and shipping; receipt and storage in the clinic; prescribing process; dispensing and patient counseling. Interviewees described opportunities for quality improvement in choosing suppliers, legal issues and staffing, cold chain integrity, medication shortages and wastage, and adherence to policies.ConclusionThe model illustrates how pharmacists address medication access as a social determinant of health, and may be helpful for policy setting, system design, benchmarking, and quality assurance by health system designers. ESA is an effective and novel method of developing such models.

Highlights

The social determinants of health include the health systems under which people live and utilize health services
This study describes the drug supply system in such a setting using a novel, qualitative method known as Event Structure Analysis (ESA) [24, 25]
The secondary objective was to learn the opinions and experiences of the healthcare workers who work in the system described

Summary

Introduction

The social determinants of health include the health systems under which people live and utilize health services. For which pharmacists are responsible, is designing drug distribution systems that ensure patients have safe and convenient access to medications This is critical for settings with poor access to health care. WHO makes it clear that it is important to address social determinants of health that create barriers to good care This would include health systems, of which medication distribution is a fundamental component [3]. To do so requires pharmacists to create systems for medication procurement, storage and distribution This is consistent with the pharmacist’s role in addressing one of the social determinants of health, namely adequate access to medications. This responsibility becomes critical when pharmacists serve a poor, rural or remote population

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Conclusion