Transcript prom0ting rational use of anti-retrovirals (arv)

KENYATTA NATIONAL HOSPITAL
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PROMOTING RATIONAL USE OF
ANTI-RETROVIRALS (ARV)
AT KENYATTA NATIONAL HOSPITAL (KNH)
IN KENYA
BY
OGILE ELIZABETH
BPharm Pg Cert EDM & RDU MPSK
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K.N.H. STAFF STRENGTH
6%
19%
Doctors &Dentists
35%
14%
Nurses
Paramedics
Admin Staff
Support Staff
26%
Authorized Establishment -6,212
KNH has a total of 9 pharmacies
In-post -5,225
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INTRODUCTION AND
PROBLEM STATEMENT
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HIV/AIDS has been viewed to affect productivity of workers and
also to increase health treatment cost. KNH also faced a similar
problem. ( Ref Kenya HIV/AIDS business Council Report ) .
In Feb1998 the KNH management decided to avail free ARV
treatment to staffs as non – scheduled/ Extraformulary drug.
In June 1999, the situation was getting out of hand.
There were no clear guidelines for prescribing and dispensing the
ARVs.
There were no proper records. Staff collected drugs from any
pharmacy. The buying and supply of ARV was erratic.
Further investigations revealed that ARV prescribing was from
other sources, not specialists only. A number of prescriptions
were not genuine. There was no monitoring and follow up on the
genuine patients.
Frequent stock out periods.
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 The
hospital management mandated the
Medical Advisory Committee ( MAC) to
review the situation and then make
recommendations.
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OVERALL GOAL
 MAC
came up with the following policy
interventions to be implemented at
prescribing and pharmacy levels.
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SETTING AND POPULATION
 Kenyatta
National Hospital.
 Prevalence of infection 10% (520)
 Staffs diagnosed to be HIV/AIDS positive
and presented with prescriptions in the
pharmacy ( about 100 patients )
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INTERVENTIONS ( MARCH 2000 )
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MAC recommendations were implemented at
prescribing and dispensing level.
PRESCRIBING
 Limiting prescribing to only 3 appropriately
trained clinical specialists and ensuring that
each patient had a specific file opened.
 The staffs had to take their prescriptions for
countersigning by Head of clinical services for
verification.
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INTERVENTION….CONTD
DISPENSING
 Dispensing was centralized to one pharmacy.
 The dispensers ensured that prescriptions were
countersigned and also had the recommended
combinations.
 Patients were required to purchase an item out
of stock and bring to the pharmacy to receive
available drugs ( Provision for reimbursement ).
 Computerized record keeping system was
introduced in the pharmacy.
 ARV monitoring form was introduced in march
2001.
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RESULTS
 Preliminary
results show that 16% of the
ARV prescriptions as at June 1999 were
not genuine ( not real patients ).
 The situation as at March 2001 show that
there was still about 2% of ungenuine
prescriptions.
 We have created a database for
monitoring ARV therapy and for controls.
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KENYATTA NATIONAL HOSPITAL ARV THERAPY MONITORING FORM
Personal Details
Patient Number:
Patient Name:
Gender:
Address:
Age:
Tel:
Weight:
E-mail:
BSA:
Clinical Parameters
CD4 count
Viral Load
Date
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Antiretroviral Therapy
Reg.
No.
Combination
Start
Date
Stop
Date
Duration
Reason for
stopping
Compliance
Toxicity
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Dispensing
Drug
Quantity
Pharmacist
Date
Collected
Next Supply
Date
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LESSON LEARNT
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It is difficult to manage ARV
treatment of staffs by staffs.
 Simple policy interventions can be
used effectively to promote
Rational ARVS usage.
BUT ……..
The patients were getting tired
( complaining ).
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CONCLUSION
Comprehensive care unit was set in
October 2002
 Comprehensive care unit ( CCU )
borrowed the concepts of the policy
interventions.
 In April 2003 the staffs HIV/AIDS
management programme was intergrated
into CCU program.
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