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ENHANCING PHARMACOTHERAPY IN A RURAL HOSPITAL IN UGANDA: A QUALITY IMPROVEMENT INITIATIVE

European Statement

Clinical Pharmacy Services

Author(s)

Julen Montoya Matellanes, María Sánchez Argáiz, Pablo González Moreno, Sister Jacinta Wajinku, Ana Soler-Rodenas, Luis Ortega Valín, David Roca Biosca

Why was it done?

The goal of this initiative was to address the challenges faced in medicine management at the hospital, including low adherence to the HDF and the presence of numerous medicines not listed in the guideline. These issues hindered effective treatment options for patients and highlighted the need to improve compliance with national guidelines.

What was done?

We conducted a comprehensive review of the hospital drug formulary (HDF) in a rural Ugandan hospital to optimize pharmacotherapy and improve local access to essential medicines. This initiative involved assessing adherence levels to the HDF, identifying therapeutic needs, and evaluating drug availability.

How was it done?

A mixed-methods approach was used, combining qualitative and quantitative data. We compared the medicines available in the storage facilities s with those listed in the current HDF (published in 2016). Key indicators, such as adherence to the HDF and the number of available medicines not included in the guideline, were calculated. In addition, interviews with the responsible pharmacist provided insights into the causes of medicine shortages. We also compared the HDF with the 2023 Uganda Clinical Guidelines and the Essential Medicines and Health Supplies List for Uganda to identify therapeutic gaps.

What has been achieved?

The review revealed that out of 234 medications listed in the HDF, only 127 (54%) were available at the hospital pharmacy, while 107 (46%) were unavailable or out of stock. Adherence to the HDF was 63%, and 164 available medications were not included in the guideline. Ninety-nine potential therapeutic gaps were identified and it was highlighted that the main reasons for drug shortages included discontinuation of compounded drugs preparation and expiry of medicines due to low usage. This initiative provided a clear picture of the severity and causes of the issues related to access to medications.

What next?

To address these challenges, we recommend implementing staff training in medication management, systematizing stock and ordering processes, updating the HDF based on clinical and economic criteria, and reactivating the magistral formulation laboratory. With these measures we aim to improve medication availability and ensure better patient outcomes in this rural hospital. Additionally, the method employed can be standardized as a valid approach to assess drug availability in any hospital, with particular relevance in low-resource countries facing economic challenges and lacking electronic inventory control systems.

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