Economic evaluation of task-shifting approaches to the dispensing of anti-retroviral therapy

Human Resources for Health

Diane McIntyre¹  Nicola Foster¹ 

[1] Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa

关键词: Anti-retroviral therapy;    Skills mix;    Pharmaceutical care models;    Task-shifting;   

Others  :  822663
DOI  :  10.1186/1478-4491-10-32

 received in 2011-08-11, accepted in 2012-06-13,  发布年份 2012

【 摘 要 】

Background

A scarcity of human resources for health has been identified as one of the primary constraints to the scale-up of the provision of Anti-Retroviral Treatment (ART). In South Africa there is a particularly severe lack of pharmacists. The study aims to compare two task-shifting approaches to the dispensing of ART: Indirectly Supervised Pharmacist’s Assistants (ISPA) and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART.

Methods

A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted.

Results

The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy.

Conclusions

While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.

【 授权许可】

   
2012 Foster and McIntyre; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kober K, Van Damme W: Scaling up access to antiretroviral treatment in Southern Africa: who will do the job? Lancet 2004, 364:103-107.
• [2]Barnighausen T, Bloom DE, Humair S: Human resources for treating HIV/AIDS: needs, capacities and gaps. AIDS Patient Care STDs 2007, 21:799-812.
• [3]Van Rensburg DH, Steyn F, Schneider H, Loffstadt L: Human resource development and antiretroviral treatment in Free State province, South Africa. Hum Resour Health 2008, 6:15-25. BioMed Central Full Text
• [4]King RC, Fomundam HN: Remodeling pharmaceutical care in Sub-Saharan Africa (SSA) amidst human resources challenges and the HIV/AIDS pandemic. Int J Health Plann Manage 2009, 25:30-48.
• [5]Pharmacy Human Resources Data. http://www.healthlink.org.za/healthstats/283/data webcite. Accessed 17 July 2012
• [6]Callaghan M, Ford N, Schneider H: A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health 2010, 8:8. BioMed Central Full Text
• [7]Fulton BD, Scheffer RM, Sparkes SP, Auh EY, Vujicic M, Soucat A: Health workforce skill mix and task shifting in low income countries: a review of recent evidence. Hum Resour Health 2011, 9:1-11. BioMed Central Full Text
• [8]Huicho L, Scherpbier RW, Nkowane AM, Victora CG: How much does quality of child care vary between health workers with differing durations of training? An observational multicountry study. Lancet 2008, 372:910-916.
• [9]Kruk M, Pereira C, Vaz F, Bergstrom S, Galea S: Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. Br J Obstet Gynaecol 2007, 114:1253-1260.
• [10]Dovlo D: Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Hum Resour Health 2004, 2:7.
• [11]Sanne I, Orrell C, Fox M, Conradie F, Ive P, Zeinecker J, Cornell M, Heiberg C, Ingram C, Panchia R, Rassool M, Gonin R, Stevens W, Truter H, Dehlinger M, van der Horst C, McIntyre J, Wood R, CIPRA-SA Study Team: Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. Lancet 2010, 376:33-40.
• [12]Chilopora G, Pereira C, Kamwendo F, Chimbiri A, Malunga E, Bergstrom S, Chilopora G, Pereira C, Kamwendo F, Chimbiri A, Malunga E, Bergstrom S: Postoperative outcome of ceasarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Hum Resour Health 2007, 5:17. BioMed Central Full Text
• [13]Herbertson R, Blundell A, Bowman C: The role of clinical support workers in reducing junior doctors' hours and improving quality of patient care. J Eval Clin Pract 2007, 13:272-275.
• [14]Pereira C, Bugalho A, Bergstrom S, Vaz F, Cotiro M: A comparative study of caesarean deliveries by assistant medical officers and obstetricians in Mozambique. Br J Obstet Gynaecol 1996, 103:508-512.
• [15]De Brouwere V, Dieng T, Diadhiou M, Witter S, Denerville E: Task shifting for emergency obstetric surgery in district hospitals in Senegal. Reprod Health Matters 2009, 17:32-44.
• [16]Hounton S, Newlands D, Meda N, De Brouwere V: A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso. Hum Resour Health 2009, 7:34. BioMed Central Full Text
• [17]McCord C, Mbaruku G, Pereira C, Nzabuhakwa C, Bergstrom S: The quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals. Health Aff 2009, 28:w876-w855.
• [18]Brentlinger P, Assan A, Mudender F, Ghee A, Torres J, Martinez P, Bacon O, Bastos R, Manuel R, Li L, McKinney C, Nelson LJ: ask shifting in Mozambique: cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care. Hum Resour Health 2010, 8:23. BioMed Central Full Text
• [19]Kinnersley P, Anderson E, Parry K, Clement J, Archard L, Turton P, Stainthorpe A, Fraser A, Butler C, Rogers C: Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting "same day" consultations in primary care. British Med J 2000, 320:1043-1048.
• [20]Buchan J, Calman L: Skill-mix and policy change in the health workforce: Nurses in advanced roles. OECD Health Working Papers 17 2004, 8:63. http://www.oecd.org/dataoecd/30/28/33857785.pdf webcite Accessed 20 July 2012
• [21]Barber S, Gertler P, Harimurti P: The contribution of human resources for health to the quality of care in Indonesia. Health Aff 2007, 26:w367-w379.
• [22]Huicho L, Scherpbier R, Nkowane A, Victora C: The Multi-Country Evaluation of IMCI Study Group. How much does quality of child care vary between health workers with differing durations of training? An observational multicountry study. Lancet 2008, 372:910-916.
• [23]Shumbusho F, van Griensven J, Lowrance D, Turate I, Weaver M, Price J, Binagwaho A: Task shifting for scale-up of HIV care: evaluation of nurse-centered antiretroviral treatment at rural health centers in Rwanda. PLoS Med 2009, 6:e1000163.
• [24]Vasan A, Kenya-Mugisha N, Seung K, Achieng M, Banura P, Lule F, Beems M, Todd J, Madraa E: Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda. Hum Resour Health 2009, 7:75. BioMed Central Full Text
• [25]Rowe S, Kelly J, Olewe M, Kleinbaum D, McGowan J, McFarland D, Rochat R, Deming M: Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya district, Kenya. Trans R Soc Trop Med Hyg 2007, 101:188-202.
• [26]Rahman A, Malik A, Sikander S, Roberts C, Creed F: Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 2008, 372:902-909.
• [27]Gary T, Batts-Turner M, Yeh H, Hill-Briggs F, Bone L, Wang N, Levine D, Powe N, Saudek C, Hill MN, McGuire M, Brancati FL: The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2009, 169:1788-1794.
• [28]Wools-Kaloustian K, Sidle J, Selke H, Vedanthan R, Kemboi E, Boit L, Jebet V, Carroll A, Tierney W, Kimaiyo S: A model for extending antiretroviral care beyond the rural health centre. J Int, AIDS Soc 2009, 12:22. BioMed Central Full Text
• [29]Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk B, Odgaard-Jensen J, Johansen M, Aja G, Zwarenstein M, Scheel I: Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev 2010, 3:CD004015.
• [30]Selke H, Kimaiyo S, Sidle J, Vedanthan R, Tierney W, Shen C, Denski C, Katschke A, Wools-Kaloustian K: Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS: clinical outcomes of a community-based program in Kenya. J Acquir Immune Defic Syndr 2010, 55:483-490.
• [31]Monteith L, Grimwood A, Pillay K: Improve access of ART at the PHC level through indirectly supervised pharmacist assistants. Keth'Impilo, Cape Town; 2010.
• [32]StataCorp: Stata Statistical Software. 10th edition. StataCorp LP, College Station, Texas; 2007.
• [33]Average Yearly Exchange Rates. www.oanda.com webcite
• [34]Drummond M, Sculpher M, Torrance G, O'Brien B, Stoddart G: Methods for the Economic Evaluation of Health Care Programmes. 3rd edition. Oxford University Press, United Kingdom; 2005.
• [35]Johns B, Baltussen R, Hutubessy R: Programme costs in the economic evaluation of health interventions. Cost Eff Resour Alloc 2003, 1:1. BioMed Central Full Text
• [36]Creese A, Parker D: Cost Analysis in Primary Health Care: A Training Manual forProgramme Managers. World Health Organization, Geneva; 1994.
• [37]Garrison LP, Mansley EC, Abbott I, Bresnahan BW, Hay JW, Smeeding J: Good research practices for measuring drug costs in cost-effectiveness analyses: asocietal perspective. Value Health 2010, 13:8-13.
• [38]Meltzer D, Johannesson M: Inconsistencies in the "societal perspective" on costs of the panel on cost-effectiveness in health and medicine. Med Decision Making 1999, 19:371-377.
• [39]Drummond M, Sculpher M, Torrance G, O'Brien B, Stoddart G: Methods for the Economic Evaluation of Health Care Programmes. 3rd edition. Oxford University Press, Oxford; 2005.
• [40]What Domestic Workers and Their Employers Should Know about Minimum Wages and Conditions of Employment. Accessed 17 July 2012. https://www.labour.gov.za/documents/useful-documents/basic-conditions-of-employment/what-domestic-workers-and-their-employers-should-know-about-minimum-wages-and-conditions-of-employment webcite
• [41]Atkinson S, El haj MA: Domain analysis for qualitative public health data. Health Policy Plan 1996, 11:438-442.
• [42]Declaration of Helsinki. 2008.
• [43]Schneider H, McIntyre D, Birch S, Eyles J: Access challenges in TB, ART and maternal health services. Phase 1 results, REACH; 2009. http://uct-heu.s3.amazonaws.com/wp-content/uploads/2010/02/USER-REPORT.pdf webcite. Accessed 17 July 2012
• [44]Ingle S, May M, Uebel K, Timmerman V, Kotze E, Bachman M, Sterne J, Egger M, Fairall L: Differences in access and patient outcomes across antiretroviral treatment clinics in the Free State province: a prospective cohort study. S Afr Med J 2010, 100:675-681.
• [45]Muula A, Ngulube T, Siziya S, Makupe C, Umar E, Prozesky H, Wiysonge C, Mataya R: Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review. Public Health 2007, 7:63-71.
• [46]Cornell M, Technau K, Fairall L, Wood R, Moultrie H, van Cutsem G, Giddy J, Mohapi L, Eley B, MacPhail P, Prozesky H, Rabie H, Davies MA, Maxwell N, Boulle A, International Epidemiologic Databases to Evaluate AIDS SouthernAfricaCollaboration: Monitoring the South African National Antiretroviral Treatment Programme, 2003–2007: The IeDEA Southern Africa collaboration. S Afr Med J 2009, 99:653-660.
• [47]Statistics South Africa: Quarterly labour force survey. Statistics South Africa; 2011:P0211. http://www.statssa.gov.za/publications/P0211/P02111stQuarter2011.pdf webcite Accessed 20 July 2012
• [48]Fredlund VG, Nash J: How far should they walk? Increasing antiretroviral therapy access in a rural community in Northern KwaZulu‒Natal, South Africa. J Infect Dis 2007, 196:S469-S473.
• [49]Tuller DM, Bangsberg DR, Senkungu J, Ware NC, Emenyonu N, Weiser SD: Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: aqualitative study. AIDS Behav 2010, 14:778-784.
• [50]Rosen S, Ketlhapile M, Sanne I, DeSilva MB: Cost to patients of obtaining treatment for HIV/Aids in South Africa. S Afr Med J 2007, 97:524-529.
• [51]Munroe W, Kunz K: Economic evaluation of pharmacist involvement in disease management in a community pharmacy setting. Clin Ther 1997, 19:113-123.
• [52]Osman L: The challenge of indirect supervision. S Afr Pharmacist Assist 2005., 4
• [53]Evans D: Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. J Clin Nurs 2003, 12:77-84.