Improving inpatient medication adherence using attendant education in a tertiary care hospital in Uganda

Int J Qual Health Care. 2017 Aug 1;29(4):587-592. doi: 10.1093/intqhc/mzx075.

Abstract

Quality problem: Although widely utilized in resource-rich health care systems, the use of quality improvement (QI) techniques is less common in resource-limited environments. Uganda is a resource-limited country in Sub-Saharan Africa that faces many challenges with health care delivery. These challenges include understaffing, inconsistent drug availability and inefficient systems that limit the provision of clinical care.

Initial assessment: Poor adherence to prescribed inpatient medications was identified as a key shortcoming of clinical care on the internal medicine wards of Mulago National Referral Hospital, Kampala, Uganda. Baseline data collection revealed a pre-intervention median inpatient medication adherence rate of 46.5% on the study ward. Deficiencies were also identified in attendant (lay caretaker) education, and prescriber and pharmacy metrics.

Choice of solution: A QI team led by a resident doctor and consisting of a QI nurse, a pharmacist and a ward nurse supervisor used standard QI techniques to address this issue.

Implementation: Plan-Do-Study-Act cycle interventions focused on attendant involvement and education, physician prescription practices and improving pharmacy communication with clinicians and attendants.

Evaluation: Significant improvements were seen with an increase in overall medication adherence from a pre-intervention baseline median of 46.5% to a post-intervention median of 92%. Attendant education proved to be the most effective intervention, though resource and staffing limitations made institutionalization of these changes difficult.

Lessons learned: QI methods may be the way forward for optimizing health care delivery in resource-limited settings like Uganda. Institutionalization of these methods remains a challenge due to shortage of staff and other resource limitations.

Keywords: human resources; leadership; quality improvement; quality management; training/education.

MeSH terms

  • Allied Health Personnel / education*
  • Communication
  • Drug Prescriptions / standards
  • Humans
  • Inpatients / statistics & numerical data
  • Medication Adherence*
  • Pharmacy Service, Hospital / organization & administration
  • Physicians
  • Quality Improvement / organization & administration*
  • Tertiary Care Centers
  • Uganda