Contextualising the Pharmacist Practicing Clinical Pharmacy in South Africa – Do we Practice What we Preach?

Abstract

Background: The National Department of Health published their Quality Standards for Healthcare Establishments in South Africa and introduced the National Health Insurance (NHI), with the pilot phase that commenced in 2012. The system requires an adequate supply of pharmaceutical personnel and the direct involvement of clinical pharmacists throughout the medication-use process to ensure continuity of care, minimised risk with increasing improvement of patient outcomes. The study aimed to provide insight into the pressing issues of clinical pharmacy practice in South Africa, and sets out to contextualise the current profile of the pharmacist performing clinical functions.Methods: The study used a quantitative, explorative, cross-sectional design. The population included pharmacists from private and public tertiary hospitals. A questionnaire was administered, using Typeform™. Ethics approval was obtained from relevant role-players. Categorical data were summarised using frequency counts and percentages; continuous data were summarised by mean values and standard deviations.Results: The sample size included 70 pharmacists (private sector n=59; public sector n=11). Most participants hold a BPharm degree (64%; n=70). No statistical significance was found between participants in private and public practice. Most pharmacist agreed (32% (private); n=59) and strongly agreed (45% (public); n=11) to have sufficient training to perform pharmaceutical care. The majority respondents felt that interventions made by the pharmacist improved the rational use of medicine (47% (private); n=59; 55% (public); n=11), that pharmacist interventions influence prescribing patterns (42% (private); n=59; 64% (public); n=11) and reduce polypharmacy (41% (private); n=59; 55% (public); n=11). Clinical functions performed most are evaluation of prescriptions (private 90%; public 82%) while the top logistical function for private is daily ordering of medication (40.7%), and public checking of ward stock (36%).Conclusion: Although not all pharmacists appointed in South Africa has completed the MPharm degree in clinical pharmacy, the pharmacists at ward level perform numerous clinical functions, even if only for a small part of their workday. This paper sets the way to standardise practices of clinical pharmacy in South Africa, with a reflection on the differences in practice in different institutions.

Exploring Factors Associated With the Motivation of Clinical Pharmacists: A Focus on the South African Context

“…Other clinical activities performed by pharmacists at ward level include therapeutic drug monitoring, taking ward rounds with the multidisciplinary team, doing medication reconciliation and providing education to patients and nursing staff. A great difference has been reported in the standard and quality of these activities between different settings/facilities ( 8 ).…”

“…This slow uptake of clinical pharmacy services in such countries is generally related to infrastructure and resource limitations [( 5 – 7 )]. Additionally, lack of motivation has been identified in South Africa (SA) as a factor for the scarce number of pharmacists working in the wards ( 8 ). In spite of this, there is a lack of qualitative research on the work motivation of medical specialists ( 9 ), especially investigation into the motivation of clinical pharmacists.…”

“…The profession of pharmacy is maturing as a clinical profession in South Africa (SA) and has experienced significant development and growth over the past 10 years ( 8 ). However, as of yet, the discipline cannot be registered as a specialization at the South African Pharmacy Council (SAPC), and as a result no official clinical pharmacist posts are available ( 8 ).…”

“…The profession of pharmacy is maturing as a clinical profession in South Africa (SA) and has experienced significant development and growth over the past 10 years ( 8 ). However, as of yet, the discipline cannot be registered as a specialization at the South African Pharmacy Council (SAPC), and as a result no official clinical pharmacist posts are available ( 8 ). The healthcare system in SA constitutes a two-tiered health system, that is the public and private health care systems, serving ~84 and 16% of the country's population, respectively ( 23 ).…”

“…In a study by Bronkhorst et al ( 8 ), pharmacists across SA experienced some form of barrier to perform their role optimally, with the main barrier perceived to be lack of dedicated time to deliver clinical services. Furthermore, this study suggested that additional investigation into the work motivation for clinical pharmacists, may be necessary to establish the success of a practice Two other studies also found that clinical pharmacists are not involved in ward rounds, because they are over-burdened with other work responsibilities ( 32 , 33 ).…”