สถานการณ์การจัดการระบบยาสำหรับเด็กในสถานพยาบาลภาครัฐ: กรณีศึกษา จังหวัดเชียงใหม่

Abstract

Access to medicines is a complex problem, especially for pediatric medicines. The lack of these medicines have resulted in off-label drug use. Hospital pharmacists play a critical role in the drug management system (DMS) to ensure that patients can access to essential medicines. The objective of this study was to explore the current DMS for pediatric medicines in public health facilities in Thailand which will lead to the further development of suggestions on the system. The study collected data from semi-structured interviews with 35 medical practitioners working in the public hospital network in Chiang Mai from February to September 2020. The questions mainly comprised topics on the pediatric drug system, the DMS for pediatric medicines in terms of selection, procurement, distribution and the promotion of rational drug use, and problems from participants’ work experiences in the DMS for pediatric medicines. A thematic analysis was conducted to analyze the collected data.

This study found that access to pediatric medications is still limited. Although the DMS for general medications is effective in ensuring thatpatientsobtain required medicines for treatment, it has a gap for children medicinesdue to the lackofdedicatedpediatric systems. Pediatric medicines were not emphasized throughout the drug selection process due to the small patient’s population and commercial unavailability of suitable pediatric medicines.

Consequently, medicine manipulation of adult dosage forms, such as extemporaneous preparations, splitting tablets or opening capsules for further compounding of freshly prepared medicines before administration by grinding and mixing with water or syrup, is inevitable. Without a standard formulation, pharmacists are required to prepare their own based on available resources and expertise. Due to the instability of compounded medicines, some were prepared and distributed weekly or monthly, while others provide tablets for adults with instructions for self-preparation before use. The development of a provincial collaboration network helps supports the current DMS for pediatric medicines. However, other system structures such as developing a national pediatric formulary or guidelines for pediatric medicine management are also crucial for sustainable improvement in the access to quality pediatric medicines.