Performance assessment of point-of-dispensing practices of donated oncology medicines: The Max Foundation

Abstract

Background Cancer is one of the leading causes of morbidity and mortality worldwide, yet financial barriers limit access to life-saving oncology drugs in low- and middle-income countries (LMICs). For the past 15 years, the Glivec® International Patient Assistance Program (GIPAP), established by Novartis and implemented in partnership with The Max Foundation, has been improving patient access to quality assured oncology drugs in LMICs. However, there have been no performance assessments to-date of medicine-related services at point-of-dispensing sites. The primary goal of this study was to evaluate the quality of performance at 48 point-of-dispensing sites located in 41 LMICs. By doing so, the evaluation establishes a baseline of the procedures’ weaknesses and the strengths for continuous quality improvement. Methods A cross-sectional embedded mixed-method study was conducted. We performed a secondary data analysis of pre-recorded data collected from January 2017 until December 2017, using a checklist and a site report template. The analysis consisted of analysis and interpretation of descriptive statistics and a directed approach to content analysis to assess the quality of ten quality categories, including storage conditions, diagnostics, and adverse event reporting. The quality of data collected was also assessed in terms of completeness and content validity. The results were used to develop a set of recommendations for future performance assessments of point-of-dispensing sites. Results Fourteen point-of-dispensing sites were classified as top performers, while 24 were classified as average performers and seven sites were called to implement most improvements. Data were 100% complete for four out of 10 selected quality categories; the other categories had 2-38% missing values. Content validity was “good” in eight quality categories, “average” in two categories and “poor” in one category. Conclusion The quality of the performance in point-of-dispensing sites as well as the quality of the performance of the assessment tool can be improved. Completeness and content validity of data collected was not achieved at a number of sites. Seven recommendations are proposed to address weaknesses of measurement procedures and data collection to ensure better performance and performance assessment at point-of-dispensing sites in the future.