Table 7 Comparison of Pharmaceutical Care models

Overview

Full-time pharmacist dispensing medication from a prescription written by a doctor, directly to the patient.

The PA works under the indirect supervision of an offsite pharmacist who conducts monthly visits and provides telephonic support. Dispenses directly to patients from a legal prescription written by a doctor. Responsible for stock control. One pharmacist is allowed to supervise up to fivePAs.

This service is often provided in conjunction with an outreach service from a larger centre or in small satellite clinics. Medication is pre-packed by a pharmacist for each patient (patient-ready packs) and delivered to the clinic from which the nurse hands out the medication and monitors the patients’ condition.

Requirements

Service is available at larger facilities, for example, at a community health centre. Dispensing is conducted from a pharmacy, operated under the personal supervision of a responsible pharmacist, licensed by the DOH and recorded with SAPC.

Dispensary has to be secure, organized, temperature controlled. Pharmaceuticals and related products are ordered, stored and dispensed directly to clients by the PA and issued to staff for treatment areas. Dispensary design and layout is similar to that of a pharmacy but with smaller floor size.

Storage of medication in a medicine room. The medicine room is intended as a secure, organized, temperature controlled room with limited access, for the bulk storage of pharmaceuticals, for refilling trolleys or cupboards in treatment rooms. No direct patient dispensing, only from patient-ready packs or according to standard operating procedures.

Benefits

Highly skilled and trained health professional, experienced in working under pressure and in a team.

More cost-effective in salary and training costs[10]

Increases access to ART for patient

Promotes rational prescribing and is therefore cost-saving

Onsite to assist in stock management and if patient comes outside of appointment dates.

Patients have established rapport with clinician

Increases access to ART

There is a perception of time saved if clinician dispenses, though each consultation will take longer.

Problems

Scarce

Insufficient training (operational management, dealing with the public/providers)

Prescriber and dispenser is the same person – potential for mistakes.

Would limit scale-up of ART service

Does not have the authority/skill to promote rational prescribing.

Nurses might not be aware of drug interactions between drug classes.

Expensive training

Limited pharmacology training

Service is likely to reach saturation point sooner.

Higher salary level

Lack of career path[52]

Higher salary level than PAs