Pilot drug and therapeutic committee programme in Sierra Leone: A descriptive mixed method study

Abstract

Aims Irrational medicine use is a global crisis, but incidences are proportionately higher in low‐ and middle‐income countries such as Sierra Leone. This study explores the structure, functions and challenges of drug and therapeutics committees (DTCs), an intervention towards irrational medicine use recently piloted in Sierra Leone. Methods A 2‐phase mixed‐method study design was used in this study. Firstly, a cross‐sectional survey was conducted on all pharmacists who have worked for at least 1 year in DTC‐piloted hospitals, using an online questionnaire to assess DTCs’ structure, indicators and challenges. In phase 2, all eligible pharmacists were invited for a semistructured online interview using the WhatsApp messaging application to get deeper insights into the key issues that emerged from the survey; however, only 5 of the 7 consented to participate. MS Excel 2019 and NVivo version 12 were respectively used for data management and analysis. Results A total of 6 survey responses and 5 interviews were included in the analysis. Participants are pharmacists from the 7 hospitals in Sierra Leone where DTC was piloted. Most DTCs are comprised of a minimum of 10 members consisting of both medical and hospital administrative staff. The main functions of DTCs are ensuring rational medicines use, monitoring and reporting adverse drug reactions. All 7 hospitals with established pilot DTCs have different subcommittees operating at varying functionality levels, ranging from effective to nonfunctional. The main challenges in DTC functions and maintenance are funding (n = 6), DTC decision implementation (n = 4), and unmotivated members (n = 4). Strategies suggested to improve DTCs at public hospitals and nationwide include resource allocation, monitoring and evaluating DTC functions and its members' capacity building. Conclusion DTCs present a compelling opportunity towards achieving rational medicines use at the hospital level in Sierra Leone. Nonetheless, the lack of funding and operational resources are significant limitations that must be noted by policymakers before expanding DTC programmes to other hospitals in Sierra Leone.

Drug and Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia

“…Conducting a regular meeting is one of the criteria for the functionality of DTC, in line with this our study found that the majority (82%) of the facilities conduct regular meetings which is slightly higher than a study conducted in UK (77%) 26 . However, a study conducted in Jordan stated, it was only two-thirds of DTCs (66%) met and conducted regular meetings 22 , 23 .…”

“…The study found out that some of the challenges of DTC implementation were poor commitment of individuals and/or HFs to implement DTCs according to the requirements and lack of a regulatory body to enforce DTC establishment and implementation which makes the tasks of DTC voluntary rather than mandatory which is similar with a study conducted in Sierra Leone which found out that unmotivated DTC members and lack of recognition of DTC activities within the facilities 26 . Moreover, a study conducted in Thailand found that poor performance monitoring and erratic national directives were some of the key gaps identified 27 which is similar to the findings of our study.…”

The pharmacists’ interventions after a Drug and Therapeutics Committee (DTC) establishment during the COVID-19 pandemic

“…It has a wide range of functions, including medication selection for the local formulary, drug information provision to medical staff, drug-use policies development and auditing, and applying standard treatment guidelines. It reduces and manages medication errors (Kabba et al, 2023 ).…”

“…Notably, there is a scarcity of research related to clinical pharmacy interventions or DTC activities to optimise treatment plans and save costs during COVID-19 in LMICs, especially in intensive care units (ICUs). Encouraging multidisciplinary collaboration of pharmacists within the health system by being involved in the DTC was previously encouraged (Arredondo et al, 2021 ; Cameron et al, 2022 ; Kabba et al, 2023 ). They can act proactively in light of the goals of this committee to reduce medication errors and expenditures.…”