Non-availability Of Drugs Research Articles

Determinants of patient satisfaction in public hospitals and their remediabilities

Problem Statement – Quality in healthcare consists of two aspects. While Technical quality primarily deals with accuracy of diagnosis and procedures and adherence to clinical protocols, service quality refers to the manner in which the health care services are delivered to patients. Since patients are often unable to accurately assess the technical quality of care, functional/ service quality is usually the primary determinant of patient’s perceptions of the quality. This study tries to crystallize ‘critical to quality’ attributes of services from array of wish list of what should be there. We also explored the possible solutions for these issues that can be implemented in public health facilities. Methodology – To develop questionnaires for Patient Satisfaction Survey, first of all ‘Voice of Customer’ (VOC) has been captured thought filed visits, interviews with patients and service providers, focus group discussions. Attributes distilled though VOC are arranged in an Ishikawa Diagram and further converted into a 10-point questionnaire for Outpatient and 20-point questionnaire for Inpatient services measuring patient perception on a five point ‘Likert’ scale ranging from poor to excellent. Feedback on this questionnaire has been taken on quarterly basis on a sample size calculated on 95% confidence level. Data would be analyzed and lowest two performing indicators would be identified for root-cause analysis and developing action plan. Data would further analyzed on Analytical Hierarchy Process Model by pair wise comparison to drill down Critical to Quality (CTQs). Relative weightage of CTQs would then be analyzed through Pareto analysis. Main Findings - Data analysis of patient satisfaction survey across 9 district hospitals of Bihar shows that patient are most dissatisfied with non-availability of drugs and quantum of consultation time in OPD, while for IPD patients, cleanliness of toilets mattered most. At the same time, non-availability of drugs is still most dissatisfying factor. Further, it is emerges through Pareto analysis that more than enhancement by 60% in patients’ satisfaction could be achieved by addressing top three attributes of dissatisfaction. Finally on Kano mode, non-availability of drugs and perception of not getting enough consultation time are ‘Dissatisfies’ , Cleanliness, ready availability of diagnostic services and prolong waiting times as ‘performers’. Nice and courteous behavior of staff of Public Hospitals are the ‘Delighter’ for the patients. Discussion - Services unlike products are produced and consumed at the same time. This characteristic increases the importance of the care provider –patient relationship as well potential for variation in service quality. With the advent of Right based approach in health, patients are no more treated as targets or beneficiaries. They are customers or right seekers and service providers should try to meet their expectations. Patient satisfaction survey is one such tool to measure, whether hospital services are meeting patients’ expectation or not. Patient satisfaction survey is an integral part of Quality Management System developed by NHSRC for Public Hospitals. These surveys helps in improving the service quality as service providers can focus on those issues, which are critical to patients and plan their services accordingly. Quality Function Deployment is one such tool that can be used for planning and implementing solutions.

Challenges if HIV Treatment in Resource-Poor Countries: A Review

The human immunodeficiency virus/acquired immunodeficiency syndrome pandemic have posed a significant public health challenge to the global community. Massive therapeutic interventions with antiretroviral drugs are being undertaken, yet problems and challenges exist. This review examines these problems and challenges as they affect the treatment of HIV infection in resource-poor countries such as Nigeria. The information was sourced from relevant literature using human immunodeficiency virus/acquired immunodeficiency syndrome journals, textbooks and Websites on human immunodeficiency virus/acquired immunodeficiency syndrome, highly active antiretroviral therapy, resource-poor countries as key words. Several studies have shown that the advent of highly active antiretroviral therapy in 1996 has significantly reduced morbidity and mortality among people living with HIV/AIDS (PLWHA). But in resource-poor countries, initiation and maintenance of highly active antiretroviral therapy has been associated with many challenges and problems such as: poor infrastructural base for the control programs; irregular or non availability of drugs; poor drug adherence; co-morbidities and opportunistic infections/malignancies; drug toxicities; drug/food and drug/drug interactions; laboratory monitoring of viral load; CD4 cell counts; full blood counts; electrolytes, kidney and liver functions. The review has shown that the solution to the pandemic lies in a multi-sectoral and holistic approach involving International and local agencies, and communities.

Patient safety incidents involving neuromuscular blockade: analysis of the UK National Reporting and Learning System data from 2006 to 2008

Neuromuscular blockade is a powerful anaesthetic tool that has the potential for significant adverse outcomes. We sought to explore the national picture by analysing incidents relating to neuromuscular blockade in anaesthesia from the National Reporting and Learning System from England and Wales between 2006 and 2008. We searched the database of incidents using SNOMED CT search terms and reading the free text of relevant incidents. There were 231 incidents arising from the use or reversal of neuromuscular blocking agents. The main themes identified were: non-availability of drugs (45 incidents, 19%), possible unintentional awareness under general anaesthesia (42 incidents, 18%), potential allergic reaction (31 incidents, 13%), problems with reversal of blockade (13 incidents, 6%), storage (13 incidents, 6%) and prolonged apnoea (11 incidents, 5%). We make recommendations to reduce human error in the use of neuromuscular blocking agents and on future incident reporting in anaesthesia.

Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria

The anti-retroviral (ARV) treatment programme in Nigeria is delivered through selected teaching and mission hospitals at a free/subsidized rate. The government aims to scale up ARV treatment in the country. However, non-adherence to ARV medication can lead to viral resistance, treatment failure, toxicities and waste of financial resources. This study examined the factors responsible for non-adherence to free/subsidized ARV treatment in south-east Nigeria. The study was cross-sectional and descriptive. Information was collected from 174 patients selected by simple random sampling from the register of all patients who had been on anti-retroviral therapy (ART) for at least 12 months at the beginning of the study period. Patients were identified during their clinic visits. Information on their socio-demographic profile, ARV treatment and determinants of non-adherence to ARV treatment was obtained from those who gave consent, using pre-tested interviewer-administered questionnaires. All patients clearly understood the need to take ARV drugs throughout their lives, and what the costs entailed. They understood the need for periodic testing, the probability that complications would develop, cost of transportation to treatment site and the daily treatment regimen. Seventy-five per cent of respondents were not adhering fully to their drug regimen; the mean number of days that respondents had been off drugs was 3.57 days the preceding month. Reasons for non-adherence included: physical discomfort (side effects); non-availability of drugs at treatment site; forgetting to carry drugs during the day; fear of social rejection; treatment being a reminder of HIV status; and selling of own drugs to those unable to enrol in the projects. Being female, under 35 years, single, and having higher educational status were significantly associated with non-adherence. It is important that policy makers and programme managers address the factors responsible for non-adherence when scaling up subsidized ARV treatment in Nigeria and other parts of sub-Saharan Africa.

Challenges for Utilization of Antenatal and Delivery Care Services in Urban Setting of Bangladesh

ABSTRACT In most developing countries like Bangladesh the health care facilities are not optimally available and usually are underutilized. The study explored the perception of urban poor women regarding pregnancy, childbirth and obstetric care services of the health centers and factors for utilization and/or nonutilization of such services. Focus group discussions were conducted among mothers with a child aged one year or below, their husband and elder female members of the family between May and June 2001 in selected geographical clusters of Dhaka city. It was revealed that women regard pregnancy and child birth as a natural process that needs no medical care unless some dire emergency arises. Taking tetanus toxoid during pregnancy was equated with availing antenatal care. Traditional birth attendant (Dai) was more preferable as birth attendant as they are available at home, like a kin to them, and affordable. Reason for not availing the services were high cost, nonavailability of drugs, hassles to get free bed, ignorance about the complications, negative cultural norm, rude behavior of health care providers, fear of cesarian section and an unfamiliar environment in the hospitals. Utilization of maternity care services can be improved through a combined effort of increasing awareness to avail skilled care and made the services more accessible and with better quality.

Complementary and Alternative Therapies in Palliative Care

AbstractGlobally, the uses of complementary and alternative therapies are emerging trend in the health care system. In India, with the constant increase in ageing population and chronic diseases most people prefer complementary and alternative medicines. The reasons include lack of local health services, financial crisis and non-availability of drugs. The common alternative medicines are ayurveda, siddha, unani, naturopathy and homeopathy, other than that the latest form of complementary therapies include hydrotherapy, music therapy, humour therapy, colour therapy and light therapy.

Consequences of HIV testing without consent

The objective of this study is to explore the HIV-infected individuals' experience with HIV testing, counselling, disclosure of diagnosis and subsequent life events following diagnosis. The method used is a questionnaire survey of 340 consecutive HIV-positive victims, seen in two health institutions in southeast Nigeria within a one-year-period, November 2003 to October 2004. Three hundred and twenty respondents answered the questionnaire, 121 were men and 199 women, with 79% in the age range 20-39 years. Most respondents had known their HIV status for 3.2 (+/-1.1) years and the majority are in the lower social class. About 80% reported that their consent for HIV test was not asked for, resulting in feelings of fear, disbelief, shock and embarrassment on learning about their HIV status. Despite the initial reaction to the diagnosis, majority (81.9%) expressed satisfaction with the pattern of disclosure of diagnosis. There was some reluctance to inform spouse/partner of the diagnosis especially among asymptomatic, unmarried, childless or divorced victims. A serodiscordant couple resulted in mistrust and increased incidence of abandonment. Apart from spouse/partner the respondents are more likely to inform their siblings of the diagnosis than parents, children or friends. Despite being supportive, the respondents are more likely to suffer more neglect from siblings than their spouse (P<0.05) but the risk of being abandoned was more with the spouse than with siblings (P<0.05). Only 32.6% of the 129 respondents on antiretroviral therapy are regular with it mainly because of cost and non-availability of drugs. Default in treatment was more evident among the unmarried, those with low educational status and treatment with antiretroviral drugs for more than two years. Proper pre- and post-test counselling, promotion of behavioural change among the society about HIV/AIDS and provision of support and cost-effective care for HIV victims is advocated.

Complementary and Alternative Therapies in Palliative Care

Globally, the uses of complementary and alternative therapies are emerging trend in the health care system. In India, with the constant increase in ageing population and chronic diseases most people prefer complementary and alternative medicines. The reasons include lack of local health services, financial crisis and non-availability of drugs. The common alternative medicines are ayurveda, siddha, unani, naturopathy and homeopathy, other than that the latest form of complementary therapies include hydrotherapy, music therapy, humour therapy, colour therapy and light therapy.

Drug supply in Nigeria

The health situation in Nigeria is typical of tropical Africa. It is characterised by high childhood and maternal mortality and a relatively short life expectancy. Mortality in childhood in due mainly to diseases like malaria, measles, poliomyelitis, tetanus, diarrhoea and acute respiratory tract infections. Diseases like filariasis, schistosomiasis and leprosy which are now readily controlled by drugs cause considerable morbidity in later life. Although the technology and tools (particularly vaccines and drugs) for the control of most of these diseases are now available, it has not been possible to make optimal use of them in Nigeria and other tropical African countries because of unfavourable social and economic conditions. The non-availability of drugs most needed for healthcare and disease control has been found to be due not only to insufficient funds but also to the use of the limited funds on expensive drugs that have little bearing on the disease pattern. The Essential Drug Programme initiated by the World, Health Organisation, now adopted by Nigeria and about 100 other countries mostly in the Third World, aims to correct this unsatisfactory drug supply situation by ensuring that the available funds are used to provide those drugs needed by the large majority of the people and are made available at all times at prices that most people can afford. The Bamako Initiative in the African Region of the World Health Organization is also designed to ensure regular availability of drugs particularly to primary healthcare facilities. Seed drugs are provided to the health institutions either by the National Government or through external aid. These are sold to patients at a small profit margin. The proceeds are then used to replenish stocks and the small profit used to improve services in the health centre. The introduction of these programmes in Nigeria has improved drug availability considerably in the past couple of years and should soon start yielding further dividend in the form of measurable improvement in the health situation.

Important Considerations in the Care of Diabetic Patients in a Developing Country (Nigeria)

Much attention has been focused on the clinical pattern of diabetes mellitus in developing countries. This has its peculiarities especially with regard to tropical pancreatic diabetes, the aetiopathogenesis of which remains speculative. However, more than the clinical pattern of the disease itself, it is the social, economic, and cultural circumstances within which the disease is managed and coped with that give it its "tropical" distinctiveness. Factors of illiteracy, poverty, lack of adequate shelter or source of safe drinking water, poor environmental sanitation, cultural misconceptions about diseases, scarce health resources, non-availability of drugs or their prohibitive cost, the sale of fake drugs, and of course the ubiquitous traditional and faith healers with their 'miracle cures', all combine to create a milieu which is hostile to the optimal management of a chronic lifelong disease like diabetes mellitus. This review focuses on these oft neglected aspects of diabetes because without due attention to them, the successful management of the diabetic patient in most developing countries will remain elusive.