Journal Article

Compliance of private pharmacies in Uganda with controlled prescription drugs regulations: a mixed-methods study

Kaggwa, Bruhan, Mulangwa, John, Sewankambo, Nelson Kaulukusi, Kitutu, Freddy Eric, Byakika-Kibwika, Pauline, Kamba, Pakoyo Fadhiru, Katabira, Elly Tebasoboke, Adome, Richard Odoi, Bollinger, Robert Cyril

2020

Overview

Background Controlled prescription drug use disorders are a growing global health challenge in Sub-Saharan Africa. Effective supply chain regulations on dispensing and stock control are important for controlling this epidemic. Since compliance with these regulations in resource-limited countries is poor, there is need to understand its predictors in order to reduce the risk of prescription drug use disorders. Methods A mixed-methods study utilizing a structured questionnaire and a simulated client guide was undertaken in Kampala and Mbale towns in Uganda. The questionnaire recorded self-reported dispensing and verified stock control practices and their covariates from 101 private pharmacies. The guide recorded actual dispensing practices from 27 pharmacies. Snowball sampling was done to enrich the sample with pharmacies that stock opioids. The mean compliance with good dispensing and stock control practices was calculated. Multivariate logistic regression analyses were applied to identify predictors of compliance. Results The mean compliance with dispensing and stock control requirements was 82.9% and 23%, respectively. Twenty percent and 40% of the pharmacies dispensed pethidine without a prescription and with invalid prescriptions, respectively. Having a pharmacist on duty (OR = 5.17; p  = 0.02), prior in-service training on narcotics regulations (OR = 3.51; p  = 0.04), and previous narcotics audits by the regulator (OR = 5.11; p  = 0.01) were independent predictors of compliance with stock control requirements. Pharmacies with a previous history of poor compliance with dispensing requirements were less likely to demonstrate good compliance (OR = 0.21; p  = 0.01). Conclusions There is suboptimal compliance to controlled prescription drug regulations among Uganda’s pharmacies. A previous history of poor compliance to dispensing requirements predicted low compliance in subsequent assessments. Training and regulatory audits increased compliance in stock control but not dispensing. Expansion of training and audits to more pharmacies and/or incentives for compliance are necessary.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Accountability / Analysis / Audits / Business logistics / Cities and towns / Compliance / Compliance audits / Compliance predictors / Controlled drug regulations / Controlled prescription drugs / Controlled Substances / Data collection / Disorders / Dispensing practices / Drug abuse / Drug and Narcotic Control / Drug stores / Drug trafficking / Drug use / Drugs / Drugstores / Epidemics / Guideline Adherence / Health / Health Psychology / Hospitals / Humans / Inservice training / Licenses / Logistic Models / Medical law / Medical practice / Medical referrals / Medicine / Medicine & Public Health / Meperidine / Methods / Mixed methods research / Nalbuphine / Narcotics / Opioids / Pharmaceuticals / Pharmacies / Pharmacists / Pharmacology/Toxicology / Pharmacy / Population / Prescription Drugs / Prescription writing / Prescriptions (Drugs) / Private Sector / Public Health / Questionnaires / Regulation / Regulatory compliance / Risk reduction / Sampling / Self Report / Snowball sampling / Social Policy / Social Work / Stock control practices / Substance use disorder / Suppliers / Supply / Training / Uganda / World health