Barriers to accessibility of ceftriaxone among adult postoperative patients at Mulago National Referral Hospital, Uganda

Abstract

<title>Abstract</title> <bold>Background:</bold> Access to ceftriaxone is still low, causing 11% of patients not to complete their treatment at health facilities in Uganda; which could increase antimicrobial resistance and poor treatment outcomes. This study aimed to explore the experiences and perspectives of access to ceftriaxone among adult postoperative patients in Mulago Hospital, Uganda. <bold>Methods:</bold> We conducted in-depth and key informant qualitative interviews in Mulago National Referral Hospital, among 14 caretakers of adult postoperative patients prescribed ceftriaxone, and 16 healthcare providers, from August to November 2023. In-depth interviews explored experiences of patient caretakers about barriers of access to ceftriaxone from hospital pharmacies. Healthcare providers provided the perspectives on access to ceftriaxone. Data were analysed using deductive thematic analysis. <bold>Results:</bold> Two themes emerged from patient caretakers’ experiences and healthcare worker perspectives of access to ceftriaxone. Participants highlighted patient-related themes where ceftriaxone availability affects access. Non-availability of ceftriaxone in the pharmacies, National Medical Store drug delivery time, direct drug procurement schedule, hospital store delivery time to pharmacy units, and medicine budget affect availability of ceftriaxone in the pharmacies. Patient caretakers revealed that pharmacy working hours affect access to ceftriaxone. They revealed that the opening and closing time, night duty coverage, and dispensers availability all affect access to ceftriaxone. Furthermore; patient caretakers revealed that pharmacy location affects access to ceftriaxone. Knowledge about pharmacy location, being given directions to the location, ability to find the location have an effect on accessibility to ceftriaxone. Secondly; participants revealed that human resource affects ceftriaxone access. The staffing levels of the pharmacy department, especially the number of staff per unit, which increases patient waiting time; coupled with lack of staff accommodation at the hospital staff houses affect access. Healthcare workers echoed lack of computerized drug management system to affect inventory management, drug promoters and askaris diversion of patients to outside pharmacies; and the hospital public image affect access. <bold>Conclusion:</bold> Strict measures to curb patient diversion to outside pharmacies, hospital pharmacies operating for 24 hours daily, and a computerized medicines management system are needed. Recruitment of pharmacy staff, workshops about attitude change, increase of the medicine and supplies budget for the hospital could improve ceftriaxone access.