Adherence to the medicine code list in primary health care military clinics in Gauteng

Abstract

According to the World Health Organisation, there should be an essential medicines list in every functioning health care system in the world. The Department of Health of South Africa published its first Essential Drugs List for Primary Health Care in 1996 and for paediatric and hospital use in 1998. The South African Defence Force published its Military Medicine Code List (MMCL) in 2002. Since the implementation of the code list in the military service, no research study has been undertaken to determine adherence to the code list by prescribers or to determine indicators for possible non-adherence to the MMCL. The main aim of the study was to evaluate prescribing adherence to the MMCL list by doctors and nurses in the Primary Health Care military clinics in Gauteng. Further objectives were to establish indicators for non-adherence and provide suggestions to improve adherence, to determine to which drugs non-adherence was directed and to determine the average number of items prescribed per prescription. A cross-sectional, mainly quantitative, descriptive study was conducted at 14 military PHC dispensing points in Gauteng. Data were collected retrospectively from 838 prescriptions, of which 348 were written by doctors and 490 by nurses. A questionnaire was used to collect data prospectively from seven doctors and 34 nurses on their perceptions of the use of the MMCL. The prescriptions were analysed for adherence to the stipulations of the MMCL. Proportions of adherent prescriptions and items were compared between prescriber type (doctors and nurses), facility type (pharmacies and dispensaries) and facility location (Northern Region, close to 1 Military Hospital and Southern Region), using the Chi-square test. Non-adherent items were tabulated and grouped. Data from the questionnaires were analysed descriptively. Indicators for possible non-adherence and suggestions for improvement of adherence were listed and grouped. The average number of items per prescription was 3.4. Overall, 89.9% of prescriptions (n=838) and 96.4% of items (n=2832) were adherent to the MMCL. xii More prescriptions written by doctors (96,8%) were adherent, compared to nurses (84,9%; P<0.001). Only a few items were responsible for non-adherence. Nonadherent items specifically for nurses included corticoid nasal sprays, azithromycin, meloxicam and ispagula husks. Adherence of prescriptions dispensed in dispensaries (no pharmacist) (93.0%) was higher compared to pharmacies (87.0%; P<0.004). Prescriptions from facilities in the South of Gauteng (96.5%) were more adherent than those near 1 Military Hospital (North) (87.7%; P<0.001). Reasons for non-adherence included staff shortages, implementation and availability of the MMCL, absence of standard treatment guidelines (STGs) in the MMCL and delayed referrals to specialist departments. Suggestions for improvement of adherence to the MMCL included better implementation and distribution of the code list, addressing staff shortages, including Standard Treatment Guidelines (STGs) in the code list and improving the referral system from clinics to hospitals.