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Yoland Irwin , Wendy Wrench Faculty of Pharmacy Rhodes University

Directions for Medicines Use: What do Patients attending the Transnet Phelophepa Health Train in Grahamstown Remember?. Yoland Irwin , Wendy Wrench Faculty of Pharmacy Rhodes University. the Phelophepa Health train. Background . Phelophepa means “good, clean health”

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Yoland Irwin , Wendy Wrench Faculty of Pharmacy Rhodes University

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  1. Directions for Medicines Use:What do Patients attending the Transnet Phelophepa Health Train in Grahamstown Remember? Yoland Irwin, Wendy Wrench Faculty of Pharmacy Rhodes University

  2. the Phelophepa Health train

  3. Background • Phelophepa means “good, clean health” • The Transnet Phelophepa health train was started in 1994 • First health train in the world • Operates annually from January to September for 36 weeks leaving time for maintenance of the train

  4. Achievements • By 2004 it had reached 15 million people around South Africa • In 2008, the Transnet Phelophepa health train was awarded the United Nations Public Service award1 • In 2009 the dispensary issued2: • 26161 prescriptions • 95529 items

  5. PHC Facilities offered to Public Health clinic – 5 examination rooms Pharmacy Dental clinic Eye clinic Psychology clinic Edu Clinic (health education for groups of 21 people)

  6. Pharmacy • 2 permanent pharmacists • Interpreter from the area • 2 pharmacy students • 2 per week • 5 universities

  7. Process Patients Follow • Patients are seen by nurses and prescriptions issued • Prescriptions are brought to the pharmacy • Medicines are dispensed and issued to the patients by the pharmacists or pharmacy students • The local interpreter assists to facilitate communication and understanding of instructions

  8. Research conducted and dispensary information

  9. Our Aim • The researchers’ aim was to gather data on: • how much of the vital information given by pharmacists is remembered by patients who receive medicines from the Transnet Phelophepa Health train

  10. Adherence • According to the WHO: • “Adherence to therapies is a primary determinant of treatment success. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems.”3 • In developed countries only 50% of patients on chronic medicines adhere correctly.3 • In developing countries, with poor access to health care, this could render our problem even greater.3

  11. Gathering Data • In January 2009, the Transnet Phelophepa health train was stationed in Grahamstown for 1 week. • Permission was obtained for • 2 pharmacy students • the authors to interview patients after leaving the pharmacy with their medication • Local interpreters assisted when necessary

  12. Information Gathered • Information was gathered over 3 days while the train was in Grahamstown • 232 patients were interviewed • 940 items of medicine had been dispensed to these patients • An average of 4.05 items per patient

  13. Items Dispensed “The Big 4” • Vit B Co • Calcium gluconate • Lenapain® • Methyl salicilate ointment

  14. Other Items Dispensed • NSAIDs – diclofenac or ibuprofen • Multivitamin syrup to children • Antibiotics • Amoxycillin • Ciprofloxacin 500mg stat dose • Pen VK • Benzyl benzoate • Tetmosol® soap

  15. Items continued Menoclove Forte® Oxybutylin BC-56 cream® Whitfieldsoint® Eye drops for variety of conditions Others

  16. Questions Asked Q1 – What is this medicine for? Q2 – How are you going to take this medicine? Q3 – How long are you going to take this medicine for? Q4 – Where will you store this medicine?

  17. Our position in relation to Pharmacy < 5 mins Pharmacy Researchers checking knowledge

  18. Results and conclusions

  19. Results Q1 - 25% did not know indication for use Q2 - 20% did not know directions for use Q3 – 68.1% knew the duration of use Q4 – 94.8% knew where to store the medicines When necessary, the correct instructions were re-iterated to the patient and comprehension checked

  20. Discussion Clear information and instructions were given to each patient in their home language at the Pharmacy But in less than 5 minutes this information was not remembered by 20-25% of patients interviewed What will be remembered by the time they get home?

  21. Conclusion More methods should be employed to enhance memory of instructions This is being addressed with the collaboration of Rhodes University and Transnet Phelophepa Health train. Some of the pictograms developed and tested at Rhodes are being implemented on the train The lack of knowledge and understanding about medicines received is a universal problem likely to be experienced in all health care facilities

  22. Acknowledgements and references

  23. Acknowledgements The students who gave up their vacation time to help gather data in this study Transnet Phelophepa staff for allowing the researchers to gather this data, and being so accommodating

  24. References 1) UN public service awards 2008 winners Transnet Phelophepa Dispensary statistics 3) WHO adherence report [ONLINE] http://www.who.int/chp/knowledge/publications/adherence_report/en/print.html

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