Improved STD Syndrome Management by a Network of Clinicians and Pharmacy Workers in Peru: The PREVEN Network

Background

Sexually Transmitted diseases (STD) syndrome management has been one cornerstone of STD treatment. Persons with STD symptoms in many countries, especially those with limited resources, often initially seek care in pharmacies. The objective of the study was to develop and evaluate an integrated network of physicians, midwives and pharmacy workers trained in STD syndromic management (The PREVEN Network) as part of a national urban community-randomized trial of sexually transmitted infection prevention in Peru.

Methods and Findings

After a comprehensive census of physicians, midwives, and pharmacies in ten intervention and ten control cities, we introduced seminars and workshops for pharmacy workers, and continuing education for physicians and midwives in intervention cities and invited graduates to join the PREVEN Network. “Prevention Salespersons” visited pharmacies, boticas and clinicians regularly for educational support and collection of information on numbers of cases of STD syndromes seen at pharmacies and by clinicians in intervention cities. Simulated patients evaluated outcomes of training of pharmacy workers with respect to adequate STD syndrome management, recommendations for condom use and for treatment of partners. In intervention cities we trained, certified, and incorporated into the PREVEN Network the workers at 623 (80.6%) of 773 pharmacies and 701 (69.6%) of 1007 physicians and midwives in private practice. Extremely high clinician and pharmacy worker turnover, 13.4% and 44% respectively in the first year, dictated continued training of new pharmacy workers and clinicians. By the end of the intervention the Network included 792 pharmacies and 597 clinicians. Pharmacies reported more cases of STDs than did clinicians. Evaluations by simulated patients showed significant and substantial improvements in the management of STD syndromes at pharmacies in intervention cities but not in control cities.

Conclusions

Training pharmacy workers linked to a referral network of clinicians proved feasible and acceptable. High turn-over was challenging but over come.     

儿童巴特综合征药物治疗一例分析暨文献复习

目的:加强对儿童巴特综合征药物治疗的认识,探讨医院药学部门的处方点评模式。方法:分析我院2015年12月的1张巴特综合征患者处方的合理性,并复习相关文献。结果:本张处方初评时被判定为不合理处方,经过临床药师与临床医师的沟通和查阅相关文献,复评时将此处方改判为合理处方,证明了我院三级处方点评模式可以提高药师审查处方的能力,确保处方点评合理、公平。结论:表面上看用药不合理的处方并不一定是真正的不合理,要深入分析处方的内涵,才能对处方进行准确的判定。三级处方点评模式能促进药师学习掌握专业知识技能,提高判断处方的能力。