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Implementation of Pharmacy Practice in a Rural Resource-Constrained Setting in Kenya

Sonak Pastakia, Pharm.D., M.P.H., BCPS, Ellen Schellhase, Pharm.D., Beatrice Jakait, B.Pharm., Imran Manji, B.Pharm., Mercy Nabwire, B.Pharm., Monica Miller,Pharm.D. 

 

United States Agency for International Development - Academic Model Providing Access to Healthcare (USAID-AMPATH), Eldoret, Kenya
Purdue University College of Pharmacy, West Lafayette, Indiana
Moi Teaching and Referral Hospital, Eldoret, Kenya
Moi University School of Medicine, Eldoret, Kenya

The mission of the United States Agency for International Development - Academic Model Providing Access to Healthcare (AMPATH) pharmacy service is to address healthcare system barriers which prevent the dissemination of high quality care in the resource-constrained setting of Western Kenya.  In order to accomplish this mission, the collaboration provides clinical and community pharmacy services and performs care-focused research designed to optimize patient outcomes.

Implementation of pharmacy services occurred in a stepwise fashion.  In 2004, pharmacy clerkship students began rounding with medical teams on the inpatient wards to assist with the shortage of available healthcare workers. Students provided clinical pharmacy services on interdisciplinary, international patient care teams leading to a higher quality of patient care. Students also assisted in the implementation of a prescription entry database designed to enhance the record keeping of antiretroviral management.  As AMPATH expanded beyond a Human Immunodeficiency Virus (HIV) focus, diabetes and anticoagulation services were established.  These services are staffed by a network of healthcare providers including an American pharmacist, a Kenyan pharmacist, pharmacy students, pharmacy technologists, nurses, physicians, and trained community health workers  and provide care to more than 2,000 patients throughout Western Kenya. The diabetes care program, established in 2007, is designed to improve care by using standardized encounter forms, summary sheets, and protocols to ensure patients receive care consistent with current standards.  This service includes a cell phone based care model to support home glucose monitoring for high risk patients.  The anticoagulation clinic, established in 2008, serves cardiology clinic patients and inpatients from internal medicine and obstetrics/gynecology.  The clinic uses point of care testing, clinic filled pillboxes, and protocols for standardized care.  Data collection in all of these services facilitates research in this understudied population.

This collaboration has advanced patient care. Pharmacy students provide 14.4 consultations per day on the inpatient wards. The most frequent consultations are medication administration record reconciliation (50.4%), chart review (14.2%), medication acquisition (5.6%), and drug information for physicians (5.2%). Training the Kenyan pharmacy staff on basic computer functions and use of the prescription entry database led to a decrease in prescription entry errors from 11% to 7.8% by the fourth week of training.  Implementation of the Diabetes Care Service led to a decrease in A1C from 13.2% at enrollment to 10.2% after three months, and 9.8% after six months. The anticoagulation clinic decreased the unsettling trend of erratic anticoagulation therapy. The average time spent in the therapeutic range is now 55% for the 170 patients followed by the clinic.

AMPATH’s innovative approach to care has given patients in a developing region access to healthcare and has produced improved health outcomes through the use of technology, pharmacy students, and pharmacist directed patient care activities.

View a pdf of the poster from the Midyear Meeting (555 KB).