HIFA's first systematic review: How primary healthcare workers obtain information for safe prescribing in LMICs

9 April, 2020

I am delighted to announce the publication in BMJ Global Health of our first systematic review: How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries.

This was a huge collective effort led by Chris Smith of the London School of Hygiene and Tropical Medicine and Nagasaki University, and supported by the Japanese Society for the Promotion of Science.

Back in May 2018 we put out a call for volunteers to help us with this review, and several HIFA members from the HIFA Prescribers and Users of Medicines expert working group (PUM) and beyond came forward to help, and are acknowledged as authors. We screened over 60,000 papers, of which 23 met our inclusion criteria. The findings confirmed 'a lack of up-to-date and relevant medicine information in low and lower middle-income settings'.

Below are the citation and abstract of our paper. On behalf of HIFA, I would like to thank all the authors and contributors. This has been a wonderful collaboration and it will greatly help to inform next steps to accelerate progress towards the vision of the HIFA PUM: A world where every prescriber and user of medicines will have access to independent, reliable, understandable information on the full range of commonly prescribed medicines – and will know where to find it.

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CITATION: How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review. Chris Smith, Michelle Helena van Velthoven, Nguyen Duc Truong, Nguyen Hai Nam, Vũ Phan Anh, Tareq Mohammed Ali AL-Ahda, Osama Gamal Hassan, Basel Kouz, Nguyen Tien Huy, Malcolm Brewster, Neil Pakenham-Walsh. BMJ Global Health 2020;5:e002094. Published on 2nd April 2020

https://gh.bmj.com/content/5/4/e002094

ABSTRACT

Background: We systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries.

Methods: We searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools.

Results: Of 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low.

Discussion: Studies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.

KEY QUESTIONS

1. What is already known? While there is a large amount of health information available, it is unclear to what extent primary healthcare workers access such information to aid prescribing in low and lower middle-income countries. Previous work found that digital health tools targeting primary healthcare workers had not been extensively studied.

2. What are the new findings? To our knowledge, this is the largest ever systematic review on how primary healthcare workers obtain health information during consultations to support decision-making for prescribing in low and lower middle-income countries. While included studies were of low quality, they indicated a lack of up-to-date and relevant medicine information which makes it challenging for prescribers in low and lower middle-income settings to access information.

3. What do the new findings imply? This study indicates a great need for high-quality studies to understand the prescribing information needs of primary healthcare workers. Internet-based sources appear to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools show promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.

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I invite all HIFA members to read and comment, and share direct with BMJ Global Health [info.bmjgh@bmj.com] and/or here on HIFA [hifa@hifaforums.org].

Personally I see this as a vital baseline assessment/situation analysis on which we can build future advocacy and action. There can be no area of health more important than access to reliable information to inform prescribing, no area of health that ios more perverted by commercial interests, and no area of health that presents such an important and growing existential threat to human existence (I am talking here of course of the predicted post-antibiotic apocalypse that would make our current struggle with coronavirus look like a walk in the park).

The HIFA Prescribers and Users of Medicines project is currently unfunded and we seek £5,000 to take us forward for the coming 12 months. If you, or someone you know, can help, please contact me: neil@hifa.org

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org