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Rhodes Logo
Transnet Logo
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
Rhodes Logo
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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
Rhodes Logo
Transnet LogoAchievements
• 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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Transnet LogoProcess Patients Follow
• 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
Rhodes Logo
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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
Rhodes Logo
Transnet LogoGathering Data
• 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
Rhodes Logo
Transnet LogoInformation Gathered
• 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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• 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