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Directions for Medicines Use:What do Patients attending the

Transnet Phelophepa Health Train in Grahamstown Remember?

Yoland Irwin, Wendy WrenchFaculty of PharmacyRhodes University

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THE PHELOPHEPA HEALTH TRAIN

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• Phelophepa means “good, clean health”• The Transnet Phelophepa health train was

started in 1994 • First health train in the world • Operates annually from January to September

for 36 weeks leaving time for maintenance of the train

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• By 2004 it had reached 15 million people around South Africa

• In 2008, the Transnet Phelophepa health train was awarded the United Nations Public Service award1

• In 2009 the dispensary issued2:– 26161 prescriptions– 95529 items

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PHC Facilities offered to Public

• Health clinic – 5 examination rooms• Pharmacy • Dental clinic• Eye clinic• Psychology clinic• Edu Clinic (health education for groups of 21

people)

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Transnet LogoPharmacy

• 2 permanent pharmacists • Interpreter from the area• 2 pharmacy students

– 2 per week– 5 universities

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• Patients are seen by nurses and prescriptions issued

• Prescriptions are brought to the pharmacy• Medicines are dispensed and issued to

the patients by the pharmacists or pharmacy students

• The local interpreter assists to facilitate communication and understanding of instructions

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RESEARCH CONDUCTED AND DISPENSARY INFORMATION

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• The researchers’ aim was to gather data on:– how much of the vital information given by

pharmacists is remembered by patients who receive medicines from the Transnet Phelophepa Health train

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Transnet LogoAdherence

• According to the WHO:– “Adherence to therapies is a primary determinant of

treatment success. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems.”3

• In developed countries only 50% of patients on chronic medicines adhere correctly.3

• In developing countries, with poor access to health care, this could render our problem even greater.3

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• In January 2009, the Transnet Phelophepa health train was stationed in Grahamstown for 1 week.

• Permission was obtained for – 2 pharmacy students – the authors

to interview patients after leaving the pharmacy with their medication

• Local interpreters assisted when necessary

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• Information was gathered over 3 days while the train was in Grahamstown

• 232 patients were interviewed• 940 items of medicine had been dispensed to

these patients• An average of 4.05 items per patient

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Items Dispensed “The Big 4”

• Vit B Co• Calcium gluconate• Lenapain®• Methyl salicilate

ointment

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• NSAIDs – diclofenac or ibuprofen• Multivitamin syrup to children• Antibiotics

– Amoxycillin– Ciprofloxacin 500mg stat dose– Pen VK

• Benzyl benzoate• Tetmosol® soap

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• Menoclove Forte®• Oxybutylin• BC-56 cream®• Whitfields oint®• Eye drops for variety of conditions• Others

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Transnet LogoQuestions Asked

• Q1 – What is this medicine for?• Q2 – How are you going to take this medicine?• Q3 – How long are you going to take this

medicine for?• Q4 – Where will you store this medicine?

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Our position in relation to Pharmacy < 5 mins

Pharmacy

Researchers checking

knowledge

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RESULTS AND CONCLUSIONS

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•Q1 - 25% did not know indication for use•Q2 - 20% did not know directions for use•Q3 – 68.1% knew the duration of use •Q4 – 94.8% knew where to store the medicines

•When necessary, the correct instructions were re-iterated to the patient and comprehension checked

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• Clear information and instructions were given to each patient in their home language at the Pharmacy

• But in less than 5 minutes this information was not remembered by 20-25% of patients interviewed

• What will be remembered by the time they get home?

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• More methods should be employed to enhance memory of instructions

• This is being addressed with the collaboration of Rhodes University and Transnet Phelophepa Health train. Some of the pictograms developed and tested at Rhodes are being implemented on the train

• The lack of knowledge and understanding about medicines received is a universal problem likely to be experienced in all health care facilities

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ACKNOWLEDGEMENTS AND REFERENCES

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• The students who gave up their vacation time to help gather data in this study

• Transnet Phelophepa staff for allowing the researchers to gather this data, and being so accommodating

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1) UN public service awards 2008 winners 2) Transnet Phelophepa Dispensary statistics3) WHO adherence report [ONLINE]

http://www.who.int/chp/knowledge/publications/adherence_report/en/print.html