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BMC Primary Care
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Research article

Access to chronic medicines: patients’ preferences for a last kilometre medicine delivery service in Cape Town, South Africa

Authors: Siraaj Adams, Mwila Mulubwa, Mea van Huyssteen, Angeni Bheekie

Published in: BMC Primary Care | Issue 1/2021

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Abstract

Background

Chronic patients are required to access their chronic medicines on a regular basis, often only to refill their repeat prescriptions. Adherence to chronic medicines is challenging and has stimulated health care providers to devise differentiated service delivery models of care to decentralise chronic medicine distribution to decrease the frequency of medicine collection at health care facilities. One such option includes a last kilometre medicine delivery service. This study investigated chronic patients’ preferences for a last kilometre medicine delivery service model.

Methods

An exploratory non-randomised quantitative study was conducted over 4 weeks at four public sector primary health care facilities in Cape Town, South Africa. Data was collected on a structured questionnaire from chronic patients queuing to receive medication at each facility’s pharmacy waiting area. Patient demographics were noted to align with preferences for chronic medicine service delivery characteristics including; mobile ordering, fee for service and location for delivery. Chi-square test and frequencies were employed to analyse data using SPSS version 23.

Results

A total of 116 patients participated in this study. Most were interested in a medicine delivery service (80.2%) and were willing to use a mobile application to order their medicines (84.5%). Almost all patients (96.8%) preferred that their medicines be delivered to their home. More than three quarters of participants were willing to pay for the service (77.6%). Chi-square test showed that gender, age group, employment status, distance to the health facility and /or average waiting time at the clinic significantly influenced the preference for certain characteristics of the medicine delivery service (p < 0.05).

Conclusion

Most participants were interested in a last kilometre medicine delivery service, especially those older than 45 years, waiting for more than 6 h at the facility, and staying within one kilometre radius of the clinic. More studies are needed to establish the influence of patients’ employment status and the distance to health facility on interest in the medicine delivery service.
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Literature
1.
Meyer JC, Schellack N, Stokes J, Lancaster R, Zeeman H, Defty D, Godman B, Steel G. Ongoing initiatives to improve the quality and efficiency of medicine use within the public healthcare system in South Africa; a preliminary study. Front Pharmacol. 2017;8:751.CrossRef
2.
Boulle A, Bock P, Osler M, Cohen K, Channing L, Hilderbrand K, Mothibi E, Zweigenthal V, Slingers N, Cloete K, Abdullah F. Antiretroviral therapy and early mortality in South Africa. Bull World Health Organ. 2008;86:678–87.CrossRef
3.
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;1:521–30.CrossRef
4.
5.
Ridgeway K, Dulli LS, Murray KR, Silverstein H, Dal Santo L, Olsen P, de Mora DD, McCarraher DR. Interventions to improve antiretroviral therapy adherence among adolescents in low-and middle-income countries: A systematic review of the literature. PLoS One. 2018;13(1):e0189770.
6.
Magadzire BP, Marchal B, Ward K. Improving access to medicines through centralised dispensing in the public sector: a case study of the chronic dispensing unit in the Western Cape Province, South Africa. BMC Health Serv Res. 2015;15(1):513.CrossRef
7.
Roy M, Moore CB, Sikazwe I, Holmes CB. A review of differentiated service delivery for HIV treatment: effectiveness, mechanisms, targeting, and scale. Curr HIV/AIDS Rep. 2019;16(4):324–34.CrossRef
8.
Schwartz SR, Baral S. Remembering individual perspectives and needs in differentiated HIV care strategies. BMJ Qual Saf. 2019;28:257–9.CrossRef
9.
Grimsrud A, Barnabas RV, Ehrenkranz P, Ford N. Evidence for scale up: the differentiated care research agenda. J Int AIDS Soc. 2017 Jul;20:22024.CrossRef
10.
Meyer-Rath G, Richter S. User fees, transport costs, and the ethics of exemption: how free is free ART? South Afr J HIV Med. 2007;8(2):52–6.CrossRef
11.
Hardon AP, Akurut D, Comoro C, Ekezie C, Irunde HF, Gerrits T, Kglatwane J, Kinsman J, Kwasa R, Maridadi J, Moroka TM. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19(5):658–65.CrossRef
12.
Pillai N, Foster N, Hanifa Y, Ndlovu N, Fielding K, Churchyard G, Chihota V, Grant AD, Vassall A. Patient costs incurred by people living with HIV/AIDS prior to ART initiation in primary healthcare facilities in Gauteng, South Africa. PloS One. 2019;14(2):e0210622.
13.
Fox MP, Pascoe S, Huber AN, Murphy J, Phokojoe M, Gorgens M, Rosen S, Wilson D, Pillay Y, Fraser-Hurt N. Adherence clubs and decentralized medication delivery to support patient retention and sustained viral suppression in care: Results from a cluster-randomized evaluation of differentiated ART delivery models in South Africa. PLoS Med. 2019;16(7):e1002874.
14.
Prust ML, Banda CK, Nyirenda R, Chimbwandira F, Kalua T, Jahn A, Eliya M, Callahan K, Ehrenkranz P, Prescott MR, McCarthy EA. Multi-month prescriptions, fast-track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals. J Int AIDS Soc. 2017;20:21650.CrossRef
15.
Bigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B, Van Damme W. Access to medicines from a health system perspective. Health Policy Plan. 2013;28(7):692–704.CrossRef
16.
Flämig K, Decroo T, van den Borne B, van de Pas R. ART adherence clubs in the Western cape of South Africa: what does the sustainability framework tell us? A scoping literature review. J Int AIDS Soc. 2019;22(3):e25235.CrossRef
17.
Eshun-Wilson I, Mukumbwa-Mwenechanya M, Kim HY, Zannolini A, Mwamba CP, Dowdy D, Kalunkumya E, Lumpa M, Beres LK, Roy M, Sharma A. Differentiated care preferences of stable patients on antiretroviral therapy in Zambia: A discrete choice experiment. J Acquir Immune Defic Syndr. 2019;81(5):540.CrossRef
18.
Magadzire BP, Marchal B, Ward K. Novel models to improve access to medicines for chronic diseases in South Africa: an analysis of stakeholder perspectives on community-based distribution models. J Pharm Policy Pract. 2016;9(1):28.CrossRef
19.
Mahler H, Searle S, Plotkin M, Kulindwa Y, Greenberg S, Mlanga E, Njeuhmeli E, Lija G. Covering the last kilometre: using gis to scale-up voluntary medical male circumcision services in Iringa and Njombe regions, Tanzania. Glob Health Sci Pract. 2015;3(3):503–15.CrossRef
20.
McLaren Z, Ardington C, Leibbrandt M. Distance as a barrier to health care access in South Africa. In: A southern Africa labour an development research unit working paper number 97. Cape Town: SALDRU, University of Cape Town; 2013.
21.
Tsolekile LP, Puoane T, Schneider H, Levitt NS, Steyn K. The roles of community health workers in management of non-communicable diseases in an urban township. Afr J Prim Health Care Fam Med. 2014;6(1):1–8.CrossRef
22.
Boswell D, Conradie S, Keshave B, Khan T, Mngadi S, Tebeile L, Van Huyssteen M, Bheekie A, Kiewiets D. Medicine runners: a community-initiated solution to chronic medicine access in underserved communities. SA Pharm J. 2018;85(4):64–7.
23.
Abdulaziz AE, Khurshid FM, Al-Dhawailie AA, Almutairi MA, Ali AA, Mohammed SA. Patients’ perception to mail order pharmacy Service in a Specialized Cardiac Center. Lat Am J Pharm. 2014;33(7):1069–74.
24.
Schmittdiel JA, Marshall CJ, Wiley D, Chau CV, Trinacty CM, Wharam JF, Duru OK, Karter AJ, Brown SD. Opportunities to encourage mail order pharmacy delivery service use for diabetes prescriptions: a qualitative study. BMC Health Serv Res. 2019 Dec;19(1):422.CrossRef
25.
Ma J, Wang L. Characteristics of mail-order pharmacy users: results from the medical expenditures panel survey. J Pharm Pract. 2018;33(3):293-8.
26.
Fernandez EV, McDaniel JA, Carroll NV. Examination of the link between medication adherence and use of mail-order pharmacies in chronic disease states. J Manag Care Spec Pharm. 2016;22(11):1247–59.PubMed
27.
28.
Slingers N, De Villiers PJ. Evaluation of the effect of the introduction of a hypertension club on the management of hypertension at a community health Centre in the Cape Town Metropole. S Afr Fam Pract. 2009;51(2):143–7.CrossRef
29.
Cohen J. Statistical Power Analysis Jbr the Behavioral. Sciences. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988. p. 18–74.
30.
Bobrow K, Farmer AJ, Springer D, Shanyinde M, Yu LM, Brennan T, Rayner B, Namane M, Steyn K, Tarassenko L, Levitt N. Mobile phone text messages to support treatment adherence in adults with high blood pressure (SMS-text adherence support [StAR]) a single-blind, randomized trial. Circulation. 2016;133(6):592–600.PubMedPubMedCentral
31.
32.
Knight L, Mukumbang FC, Schatz E. Behavioral and cognitive interventions to improve treatment adherence and access to HIV care among older adults in sub-Saharan Africa: an updated systematic review. Syst Rev. 2018;7(1):114.CrossRef
33.
O’Brien R, Hunt K, Hart G. ‘It's caveman stuff, but that is to a certain extent how guys still operate’: men's accounts of masculinity and help seeking. Soc Sci Med. 2005;61(3):503–16.CrossRef
34.
Statistics South Africa. Labour market dynamics in South Africa in 2018. Report No. 02–11-02 (2018) Pretoria: Statistics South Africa, 2020.
35.
Carls GS, Roebuck MC, Brennan TA, Slezak JA, Matlin OS, Gibson TB. Impact of medication adherence on absenteeism and short-term disability for five chronic diseases. J Occup Environ Med. 2012;54(7):792–805.CrossRef
36.
37.
National Department of Health of South Africa. Ideal Clinic Manual Version 18. South Africa. 2018 Apr.
38.
National Department of Health of South Africa. Integrated Chronic Disease Management Manual, A step-by-step guide for implementation. Pretoria: National Department of Health; 2012.
39.
Lebina L, Alaba O, Ringane A, Hlongwane K, Pule P, Oni T, Kawonga M. Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa. BMC Health Serv Res. 2019;19(1):965.CrossRef
40.
Phul S, Bessell T, Cantrill JA. Alternative delivery methods for pharmacy services. Int J Pharm Pract. 2004 Jun;12(2):53–63.CrossRef
41.
Loh BC, Wah KF, Teo CA, Khairuddin NM, Fairuz FB, Liew JE. Impact of value added services on patient waiting time at the ambulatory pharmacy Queen Elizabeth Hospital. Pharm Pract (Granada). 2017;15(1):846-52.
42.
Alam S, Osama M, Iqbal F, Sawar I. Reducing pharmacy patient waiting time. Int J Health Care Qual Assur. 2018;31(7):834-44.
43.
Labrique A, Vasudevan L, Weiss W, Wilson K. Establishing standards to evaluate the impact of integrating digital health into health systems. Global Health: Science and Practice. 2018 Oct 10;6(Supplement 1):S5–17.
44.
Finitsis DJ, Pellowski JA, Johnson BT. Text message intervention designs to promote adherence to antiretroviral therapy (ART): a meta-analysis of randomized controlled trials. PloS One. 2014;9(2):e88166.
45.
Statistics South Africa. Gender statistics in South Africa, 2011. Pretoria: Statistics South Africa; 2012.
46.
Nwosu CO, Ndinda C. Gender-based household compositional changes and implications for poverty in South Africa. J Int Women's Stud. 2018;19(5):82–94.
47.
48.
Bobbins AC, Burton S, Fogarty TL. Different models of pharmaceutical services and care in primary healthcare clinics in the Eastern Cape, South Africa: Challenges and opportunities for pharmacy practice. Afr J Prim Health Care Fam Med. 2020;12(1):a2323.
49.
50.
Brey Z, Mash R, Goliath C, Roman D. Home delivery of medication during coronavirus disease 2019, Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020;12(1):4.CrossRef
51.
Akintola O, Chikoko G. Factors influencing motivation and job satisfaction among supervisors of community health workers in marginalized communities in South Africa. Hum Resour Health. 2016 Dec 1;14(1):54.CrossRef
52.
Venables E, Edwards JK, Baert S, Etienne W, Khabala K, Bygrave H. " They just come, pick and go." the acceptability of integrated medication adherence clubs for HIV and non-communicable disease (NCD) patients in Kibera, Kenya. PloS One. 2016;11(10):e0164634.
Metadata
Title
Access to chronic medicines: patients’ preferences for a last kilometre medicine delivery service in Cape Town, South Africa
Authors
Siraaj Adams
Mwila Mulubwa
Mea van Huyssteen
Angeni Bheekie
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01392-1

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