John Rovers

Motivations, barriers and ethical understandings of healthcare student volunteers on a medical service trip: a mixed methods study

BackgroundThe motivation to volunteer on a medical service trip (MST) may involve more than a simple desire for philanthropy. Some volunteers may be motivated by an intrinsic interest in volunteering in which the context of the volunteer activity is less important. Others may volunteer because the context of their volunteering is more important than their intrinsic interest in volunteering. Furthermore, MSTs may pose a variety of ethical problems that volunteers should consider prior to engaging in a trip. This study evaluated the motivations and barriers for graduate health care students volunteering for an MST to either the Dominican Republic or Mississippi. Volunteers’ understanding of some of the ethical issues associated with MSTs was also assessed.MethodsThirty-five graduate health professions students who volunteered on an MST were asked to complete an online survey. Students’ motivations and barriers for volunteering were assessed using a 5-point Likert scale and Fisher’s exact test. Ethical understanding of issues in volunteering was assessed using thematic analysis.ResultsStudents’ motivations for volunteering appeared to be related to the medical context of their service more than an inherent desire for volunteer work. Significant differences were seen in motivations and barriers for some student groups, especially those whose volunteer work had less opportunity for clinical service. Thematic analysis revealed two major themes and suggested that students had an empirical understanding that volunteer work could have both positive and negative effects.ConclusionsAn understanding of students’ motivations for volunteering on an MST may allow faculty to design trips with activities that effectively address student motivations. Although students had a basic understanding of some of the ethical issues involved, they had not considered the impact of a service group on the in-country partners they work with.

Expanding the scope of medical mission volunteer groups to include a research component

BackgroundServing on volunteer groups undertaking medical mission trips is a common activity for health care professionals and students. Although volunteers hope such work will assist underserved populations, medical mission groups have been criticized for not providing sustainable health services that focus on underlying health problems. As members of a volunteer medical mission group, we performed a bed net indicator study in rural Mali. We undertook this project to demonstrate that volunteers are capable of undertaking small-scale research, the results of which offer locally relevant results useful for disease prevention programs. The results of such projects are potentially sustainable beyond the duration of a mission trip.MethodsVolunteers with Medicine for Mali interviewed 108 households in Nana Kenieba, Mali during a routine two-week medical mission trip. Interviewees were asked structured questions about family demographics, use of insecticide treated bed nets the previous evening, as well as about benefits of net use and knowledge of malaria. Survey results were analyzed using logistic regression.ResultsWe found that 43.7% of households had any family member sleep under a bed net the previous evening. Eighty seven percent of households owned at least one ITN and the average household owned 1.95 nets. The regression model showed that paying for a net was significantly correlated with its use, while low perceived mosquito density, obtaining the net from the public sector and more than four years of education in the male head of the household were negatively correlated with net use. These results differ from national Malian data and peer-reviewed studies of bed net use.ConclusionsWe completed a bed net study that provided results that were specific to our service area. Since these results were dissimilar to peer-reviewed literature and Malian national level data on bed net use, the results will be useful to develop locally specific teaching materials on malaria prevention. This preventive focus is potentially more sustainable than clinical services for malaria treatment. Although we were not able to demonstrate that our work is sustainable, our study shows that volunteer groups are capable of undertaking research that is relevant to their service area.

Role of the Pharmacist in Childhood Immunizations

OBJECTIVE Fewer than half of the 2-year-old children in the United States are fully immunized. This article reviews the literature on barriers to immunization in children and examines how pharmacists can promote childhood immunizations by acting as an educational resource and providing increased access to vaccines. DATA SOURCES Published data were collected from the literature. Anecdotal data were collected from unstructured interviews with parents and health care professionals at two childhood immunization clinics in Des Moines, Iowa. DATA SYNTHESIS Data from the literature were compared with data informally collected in the clinics. Both the literature and interviews indicated a variety of structural and personal barriers that may prevent parents from having children vaccinated. CONCLUSION By collecting and documenting adequate vaccination histories, pharmacists can be a resource for parents and health care professionals who are unsure of a childs immunization status. Pharmacists may wish to establish immunization clinics in their pharmacies as a method to increase access to vaccines.

Pharmacy Practice around the World

Fip structure APhA is a member organization of FIP, which is made up of more than 130 pharmacy organizations representing approximately 120 countries around the world. Representing more than 60,000 U.S. pharmacists and student pharmacists, APhA is the largest membership organization represented in FIP. Although FIP is a federation of pharmacy organizations, individual pharmacists also are members. The basic structure is a governing board or bureau that oversees the organizations work and two subdivisions: the Bureau of Pharmacy Practice and the Bureau of Pharmaceutical Science. These are roughly equivalent to APhA’s Academy of Pharmacy Practice and Management (APPM) and Academy of Pharmacy Research and Science (APRS). Within each bureau, sections for various disciplines exist, again much like the structure of the APhA Academies. APhA has traditionally been represented on the governing body of the Community Pharmacy Section of FIP, which is the largest of the FIP sections (~2,500 individual members). The American Society of Health-System Pharmacists is also an organizational member of FIP and generally has representatives in the Hospital Section. U.S. pharmacists also are members of other sections, but for the United States. Most of the countries represented have highly developed pharmacy systems with specific educational, economic, and regulatory structures in place. However, FIP CPS also represents pharmacists and pharmacy organizations from many developing and third-world countries where substantial differences are found in all areas. China is a good example of a developing country that is represented by its major organization in FIP, but China has not really defined what a pharmacist is and, consequently, pharmacy education ranges from courses that produce what most of the world would call a pharmacy technician to PhD programs that tend to produce pharmaceutical scientists. Community pharmacy in China is practiced mostly in hospitals, which are really the primary health centers, and those facilities will usually have a “western medicine” pharmacy and a “traditional Chinese medicine” pharmacy that usually share a waiting area.

A drug procurement, storage and distribution model in public hospitals in a developing country

BACKGROUND There is growing interest in pharmaceutical supply chains and distribution of medications at national and international levels. Issues of access and efficiency have been called into question. However, evaluations of system outcomes are not possible unless there are contextual data to describe the systems in question. Available guidelines provided by international advisory bodies such as the World Health Organization and the International Pharmacy Federation may be useful for developing countries like Vietnam when seeking to describe the pharmaceutical system. OBJECTIVE The purpose of this study was to describe a conceptual model for drug procurement, storage, and distribution in four government-owned hospitals in Vietnam. METHOD This study was qualitative and used semi-structured interviews with key informants from within the Vietnamese pharmaceutical system. Translated transcriptions were used to conduct a content analysis of the data. RESULTS A conceptual model for the Vietnamese pharmaceutical system was described using structural and functional components. This model showed that in Vietnam, governmental policy influences the structural framework of the system, but allows for flexibility at the functional level of practice. Further, this model can be strongly differentiated from the models described by international advisory bodies. This study demonstrates a method for health care systems to describe their own models of drug distribution to address quality assurance, systems design and benchmarking for quality improvement.

A model for a drug distribution system in remote Australia as a social determinant of health using event structure analysis

BackgroundThe social determinants of health include the health systems under which people live and utilize health services. One social determinant, for which pharmacists are responsible, is designing drug distribution systems that ensure patients have safe and convenient access to medications. This is critical for settings with poor access to health care. Rural and remote Australia is one example of a setting where the pharmacy profession, schools of pharmacy, and regulatory agencies require pharmacists to assure medication access. Studies of drug distribution systems in such settings are uncommon. This study describes a model for a drug distribution system in an Aboriginal Health Service in remote Australia. The results may be useful for policy setting, pharmacy system design, health professions education, benchmarking, or quality assurance efforts for health system managers in similarly remote locations. The results also suggest that pharmacists can promote access to medications as a social determinant of health.The primary objective of this study was to propose a model for a drug procurement, storage, and distribution system in a remote region of Australia. The secondary objective was to learn the opinions and experiences of healthcare workers under the model.MethodsQualitative research methods were used. Semi-structured interviews were performed with a convenience sample of 11 individuals employed by an Aboriginal health service. Transcripts were analyzed using Event Structure Analysis (ESA) to develop the model. Transcripts were also analyzed to determine the opinions and experiences of health care workers.ResultsThe model was comprised of 24 unique steps with seven distinct components: choosing a supplier; creating a list of preferred medications; budgeting and ordering; supply and shipping; receipt and storage in the clinic; prescribing process; dispensing and patient counseling. Interviewees described opportunities for quality improvement in choosing suppliers, legal issues and staffing, cold chain integrity, medication shortages and wastage, and adherence to policies.ConclusionThe model illustrates how pharmacists address medication access as a social determinant of health, and may be helpful for policy setting, system design, benchmarking, and quality assurance by health system designers. ESA is an effective and novel method of developing such models.

Quality and stability of artemether-lumefantrine stored under ambient conditions in rural Mali.

BackgroundThe quality and stability of anti-malarial drugs in the Global South has long been of significant concern. Drug quality can be affected by poor or fraudulent manufacturing processes, while drug stability is affected by temperature and humidity. Knowledge of drug quality and stability is often the unique contribution of pharmacists volunteering on short-term medical mission trips.ObjectiveTo determine the quality and stability of artemether-lumefantrine 20/120 mg under ambient storage conditions in rural Mali.MethodsOne unopened blister pack of artemether-lumefantrine 20/120 mg (IPCA Laboratories, Mumbai) was stored under ambient conditions in a warehouse in a Malian village for one year. A second pack from the same lot number was stored under temperature and humidity controlled conditions in a university laboratory. The active ingredients of tablets from both packages were analysed using thin layer chromatography, nuclear magnetic resonance and infrared spectroscopy. The IPCA samples were referenced for drug identity and content to an identical American made product (Coartem ®, Novartis Pharmaceuticals).ResultsThin layer chromatographs, nuclear magnetic resonance and infrared spectroscopy results were identical for both IPCA samples and the reference product.ConclusionsThe IPCA products contained the same drugs in the same amount as on their package label and were identical to the reference product. It is concluded that they were of good quality. Spectroscopy results demonstrate the sample stored in Mali was stable for one year. Pharmacists volunteering on medical mission trips may dispense this product with confidence. At the end of a mission trip, pharmacists may store left over artemether-lumefantrine under ambient conditions for up to one year without concern for significant degradation of the active ingredients.